Diclofenac sodium and Allopurinol induced Stevens Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs

Abstract

One of the life-threatening multi-organ emergency conditions is Stevens-Johnson Syndrome (SJS). Although this is a rare disease and manifests as drug reactions, this condition can cause death.We present a case of a 63-year-old male with Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs.The patient was undergoing outpatient TB treatment at the end of the first month. The patient comes to the emergency department of the hospital because of shortness of breath, fever, blistered skin, nasal and oral mucosa, cracks and wounds, visible pus, red eyes accompanied by erythematous rash all over the body after previously taking diclofenac sodium and allopurinol given by the doctor because felt joint pain all over body and uric acid increased. On physical examination of the lungs, crackles and wheezing were heard in both lung fields. The chest radiograph shows infiltrates in both lung fields. Laboratory results showed leukocytosis and the results of other blood laboratory tests were still within normal limits. Patient diagnosed Stevens-Johnson Syndrome based on clinical, laboratory, and radiology examination results. The patient was given treatments using nasal canule oxygen of 5 litres/minute, intravenous fluid dehydration D5% : NaCl 0.9%, ceftriaxone injection, gentamicin injection, dexamethasone injection, cetirizine ranitidine injection, compresses with 0.9% NaCl liquid, 2.5% hydrocortisone ointment. The patient was treated in the Intensive Care Unit for 8 days. The patient had no history of previous drug allergies. In this case, the likelihood of Diclofenac sodium and Allopurinol induced Stevens_Johnson Syndrome in pulmonary tuberculosis patients receiving intensive phase first-line antituberculosis drugs, needs to be a concerned, as well as the importance of evaluation and strict follow-up to prevent Stevens Johnson Syndrome disease.