Stevens-Johnson Syndrome (SJS) - Toxic Epidermal Necrolysis (TEN) Overlap due to Cotrimoxazole in a Patient with Acquired Immune Deficiency Syndrome (AIDS): A Case Report

Background: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and SJS/TEN overlap syndrome are rare, immunologically-mediated skin reactions with severe dermatologic features that are usually triggered by exposure to drugs and/or other external agents. SJS manifested as less than 10% of the body surface area (BSA) affected in forms of skin detachment, whereas more than 30% involvement occur in TEN. Cases with BSA involvement in between mentioned range (10-30%) are then defined as of SJS–TEN overlap syndrome. SJS—TEN morbidity typically manifests at 40 years of age or older. Higher mortality was found in SJS/TEN overlap patients rather than SJS. The therapy given to SJS/TEN overlap patients is supportive therapy according to complaints. The most important thing is to stop drugs that are suspected to be triggers. Case presentation: A 59-year-old male with SJS-TEN overlap, manifested as maculopapular rash with detachment of epidermis and a positive Nikolsky sign about 25% BSA. The patient had a history of taking cotrimoxazole for toxoplasmosis therapy before symptoms appeared. Multiple widespread lesions found all over the body, with maculopapular hyperpigmentation, black crust-covered erosion from the bullae, and numerous erosions on the lip mucosa covered in brown crusts. The management of this patient was supportive therapy and stop the suspected drug. Within a few weeks, the patient's condition improved without sequelae. Conclusion: Overlapped SJS-TEN is cutaneous adverse reactions with immunologically-mediated dermatological disorders, with 10-30% BSA skin detachment. Management includes stopping all suspected cause, high dose steroid administration, along with supportive symptomatic therapy.