Stevens-Johnson syndrome due to strontium ranelate.

systemic steroids – initially intravenous hydrocortisone 100 mg 8-hourly for 3 days, followed by oral prednisolone 50 mg a day – as well as topical triamcinolone oral paste and an antiseptic mouthwash. She responded well to treatment. Strontium ranelate is a relatively new medication for the treatment of post-menopausal osteoporosis. It simultaneously increases bone formation and decreases bone resorption, thus rebalancing bone turnover in favor of bone formation.1 Drug rash with eosinophilia and systemic symptoms (DRESS) related to strontium ranelate2,3 has been well documented in the literature with more than 15 cases reported in Europe, including 2 deaths, prompting European health authorities to publish a warning concerning the risk of strontium ranelate-induced DRESS.4 Toxic epidermal necrolysis (TEN)5 and generalised exfoliative dermatitis6 caused by strontium ranelate have also been reported, but none so far on SJS. In contrast, allergy or adverse cutaneous drug reactions to bisphosphonates, which has been widely used for the past 2 decades, are very infrequent and are thought to be IgE-mediated.7 Alendronate, an aminobisphosphonate, also induces histidine decarboxylase, the enzyme that leads to histamine formation. Maculopapular rash8 and urticarial eruption7 secondary to alendronate use have been reported in the literature.