Carbamazepine induced Stevens-Johnson syndrome.

To cite: Khoo ABS, Ali FR, Yiu ZZN, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2016214926 DESCRIPTION A 36-year-old Sri Lankan man had a 10-year history of epilepsy, which was well controlled on sodium valproate. Having run out of his regular medication on vacation, he started taking his sister’s carbamazepine. He presented to the emergency department 9 days later with general malaise and widespread blisters. On examination, he was febrile, tachycardic and had centrally blistered targetoid skin lesions (figure 1), and pronounced oral and genital mucosal ulceration (figure 2). This was consistent with a diagnosis of Stevens-Johnson syndrome (SJS), a drug-induced dermatological emergency on a continuum with toxic epidermal necrolysis (TEN). Common precipitants of SJS include anticonvulsants, antibiotics (notably sulfonamides), allopurinol and non-steroidal anti-inflammatory drugs. The mainstay of management is stopping the offending agent and meticulous supportive care. Active interventions including systemic corticosteroids, intravenous immunoglobulin and ciclosporin have been tried in patients with SJS–TEN, but the evidence for benefit is inconclusive. In patients of