Fluconazole-induced Stevens-Johnson syndrome at Libreville University Hospital - Gabon: A case report

Abstract

Background

Stevens-Johnson syndrome (SJS), a rare and severe toxic epidermal necrolysis, is reported here for the first time at the University Hospital Center of Libreville (CHUL), suspected to be related to fluconazole administration.

Objective

To inform clinicians about the risks associated with fluconazole in immunocompromised patients and the related healthcare expenses.

Case presentation

The patient is a 39-year-old immunocompromised woman who received a single dose 400 mg of fluconazole. Two weeks later, she developed a rash affecting approximately 10 % of her body surface, confirmed as SJS. During clinical examinations, no signs of infection, such as fever, dizziness, or chills, were present, suggesting a drug-induced SJS reaction.

Results

Causality assessment assigned an intrinsic score of I6 and extrinsic score of B2 according to the French method, and a probable temporal relationship was confirmed using the world Health Organization (WHO) method. The ALDEN scale identified fluconazole as the probable cause (score = 4). No additional risk factors were identified (SCORTEN = 0, predicted mortality: 3.2 %). Economically, the total direct medical cost of hospitalization amounted to 605,700 CFA francs, or 923.38 €.

Conclusion

Immunocompromised HIV-positive patients treated with 400 mg of fluconazole are likely to develop SJS and incur costs.