Steven Johnson Syndrome (SJS) is an acute, fatal reaction you can have to a medication, and one such medication is phenytoin. The drug phenytoin is an antiepileptic that was prescribed to a 43-year-old male who developed both SJS and myocarditis – two of the most severe side effects of the medication.

Currently, it has been established that SJS can occur to anyone who has a drug reaction with a higher incidence in people in their 40s. This case report is about a 43-year-old male who was put on 100 mg phenytoin three times a day for seizures. Initially, he experienced sudden onset of fluid-filled bullae that vastly increased over 48 hours.

 
It was four days after he began feeling his symptoms that he came to the hospital. At the time of hospitalization, he was not taking any other medication and also complained of fever, fatigability, and shortness of breath. When he was in the emergency room he was in respiratory distress, unconscious, and not responding to deep stimuli.

 
The ER staff quickly intubated him and began medications to alleviate his symptoms. At this time, over 30% of his body was covered in ruptured bullae. After stabilization, he was transferred to the Intensive Care Unit (ICU) where the team continued his care and added hydrocortisone 100 mg intramuscular (IM) and his phenytoin was discontinued and replaced by valproic acid 1000 mg twice a day.

 
Within twelve hours of admission, he had severe renal dysregulation, his blood pressure was palpable at 80/60 mmHg, and his Glasgow coma score was 4/15. The ICU team determined he was in septic shock that was not improved by the medications. Then, six hours later, he went into cardiac arrest and was revived.

 
Unfortunately, an hour later he went into cardiac arrest again and was declared dead after efforts to revive failed. From this case study, it has been further established that proper patient care about their medication is necessary. This unfortunate male lost his life to a life-threatening phenomenon that could have been avoided if he was given another drug instead.

 
It is medically improbable for a physician to know exactly how one drug affects someone, however, if he had known the way he was feeling was a potential side effect, maybe he would have sought medical care earlier. Early recognition and diagnosis is necessary for SJS, or else the mortality rate increases. The additive diagnosis of myocarditis that led to further heart failure in this patient also did not help his case, hence, the prescribing physician should have been more thorough.

 
For all our readers and clients, if you’re taking a new medication and you start getting a rash, and you see blisters while your skin starts to peel, stop taking the medication immediately and get to your doctor as soon as possible. Afterwards, contact us at McKinney, Texas today if you or a loved one have suffered from SJS because of medication error or medical negligence.