A CASE REPORT: DRUG-INDUCED STEVENS-JOHNSON SYNDROME-TOXIC EPIDERMAL NECROLYSIS OVERLAP

Background: Itraconazole, a triazole antifungal, inhibits ergosterol synthesis in fungal cell membranes, with its active metabolite hydroxyitraconazole enhancing its efficacy. Cefadroxil, a first-generation cephalosporin, is commonly used for treating respiratory, urinary, skin, and soft tissue infections, owing to its good oral bioavailability and efficacy against Gram-positive and selected Gram-negative organisms. While both drugs are generally well-tolerated, rare but serious adverse skin reactions such as Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (SJS-TEN) have been reported. Case History: A 37-year-old male who developed multiple fluid-filled and erythematous lesions across various body regions, associated with burning and pain. Symptoms emerged seven days after initiating itraconazole and cefadroxil for skin lesions prescribed by a private practitioner. Clinical findings suggested a drug-induced hypersensitivity reaction. Both drugs were discontinued, and the patient was hospitalized. A diagnosis of SJS-TEN overlap was established based on the extent and severity of skin involvement. Management included systemic corticosteroids, cyclosporine, and supportive topical care. The patient responded well to treatment and was discharged in stable condition. Conclusion: This case highlights the potential for itraconazole and cefadroxil to cause severe cutaneous adverse reactions, emphasizing the need for early recognition and immediate discontinuation of suspected agents. Awareness of such rare yet life-threatening events is crucial for clinicians to ensure prompt intervention, improving patient outcomes and medication safety.