Diagnostic Challenge in Distinguishing Steven Johnson Syndrome/ Toxic Epidermal Necrolysis from Dengue in Endemic Areas

Abstract

This case report discusses the clinical course of a female in her mid-20s with a history of seizure disorder who presented with a fever and rapidly evolving dermatological symptoms, later diagnosed as Stevens-Johnson Syndrome (SJS) with Toxic Epidermal Necrolysis (TEN) overlap. Initially presenting with high-grade fever, cough, hypotension, and tachycardia, the patient’s recent travel to a dengue-endemic area led to initial suspicion of an infectious etiology, including dengue fever. However, negative tropical disease tests and the subsequent development of erythematous and painful maculopapular rashes, coupled with mucosal involvement, shifted the diagnosis towards a severe drug reaction. The recent addition of phenytoin to her antiepileptic regimen was identified as the likely trigger for SJS/TEN. With a SCORTEN score of 4, the patient received prompt treatment, including intravenous hydrocortisone and later oral prednisolone along with supportive care.

Keywords: Dengue, Drug-induced rash, Stevens-Johnson Syndrome, Toxic Epidermal Necrolysis, Phenytoin