CO14 | Acute liver failure: is it just a matter of Stevens-Johnson syndrome?

Background: Stevens-Johnson Syndrome (SJS) is a severe mucocutaneous adverse reaction often provoked by drugs.Case report: A 76-year-old man went to the emergency department for desquamative erythema, jaundice and fatigue appeared after recent start of treatment with allopurinol. Examination did not reveal fever, tachycardia or hypotension. Laboratory findings showed elevated levels of creatinine, transaminases, bilirubin and lipase. Chest-abdomen-computed tomography excluded dilatation of bile ducts or hydronephrosis. Systemic infection was excluded. Serology and quantitative PCR analyses of hepatitis viruses were negative; only a positive Cytomegalovirus (CMV)-immunoglobulin G was detected. Dermatological examination suggested SJS diagnosis. It was then concluded for a case of SJS with multiorgan failure induced by allopurinol. Systemic corticosteroid and fluid therapy was started obtaining both clinical and laboratory improvement: dermatological symptoms reduced, as well as creatinine and lipase levels. On the contrary, bilirubin levels were persistently increasing. Quantitative PCR analyses of hepatitis viruses was therefore repeated showing an active CMV infection. Antiviral therapy with ganciclovir was started with reduction of viral load and normalization of bilirubin levels.Conclusions: Herpesviruses reactivation is rarely documented in SJS and its relation to the pathogenesis of the disease or the corticosteroid therapy remains unclear. Nevertheless we highlight the importance of investigating it in every case of severe drug eruption as a major prognostic factor.