Overlap Stevens-Johnson syndrome-toxic epidermal necrolysis after carbamazepine, usage with heroin and alcohol abuse

A 28 year old patient developed a severe bullous exanthem and enanthem comb ined with hepatitis, fever and blood count abnormalities after taking carba mazepine and consumption of heroin and alcohol. After discontinuing carbama zepine, prednisolone was given over a five day period accompanied by intrav enous fluid and electrolyte substitution and local therapy which lead to im provement. Severe bullous skin reactions nowadays are classified into eryth ema exsudativum multiforme majus (EEMM), Stevens-Johnson syndrome (SJS), ov erlap Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS/TEN),TEN wit h maculae and TEN on large erythema,and they are most often caused by antib iotics and anticonvulsant drugs. Heroin and alcohol abuse alters host immun ity wh ich subsequently may increase susceptibility to allergic reactions. There is a high (40%) mortality rate for TEN, and patients with organ invol vement are at increased risk.