Adverse Drug Reaction to Paracetamol: Case Report of Oral Manifestation of Stevens-Johnson Syndrome in Children

Tiara Resmi,1 Rita Wardhani,2 Nanan Nur’aeny3 1Oral Medicine Residency Program, Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, Indonesia; 2Oral Medicine Specialist, Ciamis Regional General Hospital, Ciamis, West Java, Indonesia; 3Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Bandung, West Java, IndonesiaCorrespondence: Tiara Resmi, Oral Medicine Residency Program, Department of Oral Medicine, Faculty of Dentistry, Universitas Padjadjaran, Jalan Sekeloa Selatan I, Bandung, West Java, 40132, Indonesia, Tel +6281313566260, Fax +62222533043, Email Email [email protected]: A rare but serious immunologically driven adverse medication reaction is known as Stevens-Johnson Syndrome (SJS). Although paracetamol is commonly used as an analgesic and antipyretic and is thought to be safe, it can occasionally cause serious hypersensitivity reactions, including SJS. This case study details a young kid who experienced severe oral symptoms of SJS after being exposed to paracetamol.Case(s) Presentation: A 13-year-old girl complained of redness, particularly around her mouth and feet. When the upper and lower lips were examined extraoral, there was significant bleeding along with swelling and hemorrhagic crusts. The case has been diagnosed with SJS e.c. based on the physical examination, clinical examination and medical history. Susp. Paracetamol. The patient received treatment with 25 mg of Vaseline applied topically, 0.9% NaCl, 0.1% Minosep, and 0.1% mometasone furoate. The patient recovered without any complaints following 21 days of treatment.Discussion: One of the most used medications, paracetamol, has some adverse effects, including SJS. Granule-mediated exocytosis, drug-specific CD8+ cytotoxic lymphocytes, the FasL pathway, and TNF-alpha are four primary pathophysiological pathways that account for drug responses. These mechanisms are involved in apoptotic processes that lead to significant mucosal erosion and ulceration, as well as tissue damage and inflammation in the oral mucosa.Conclusion: Paracetamol, while commonly considered safe for children, can seldom induce severe delayed-type hypersensitivity events, including Stevens-Johnson syndrome (SJS). This instance illustrates that pediatric patients continue to be susceptible to drug-induced hypersensitivity, even with frequently administered drugs. Clinicians must remain alert for initial indications of hypersensitivity responses.Keywords: adverse drug reaction, SJS, paracetamol