A WOMAN suffered a horrific reaction to ibuprofen after a single dose, breaking out in scales across her skin and oozing yellow gunk from her eyes.
The 45-year-old visited the emergency department with severely swollen face, red eyes oozing discharge, yellow-crusted lips and a rash covering her chest and limbs.
She’d taken a single 800mg of ibuprofen just four hours earlier, after experiencing flu-like symptoms, according to a report published in the journal Clinical Case Reports.
The woman, from Iraq, was diagnosed with Stevens–Johnson Syndrome (SJS), a severe and potentially life-threatening skin disorder associated with certain medications, including ibuprofen.
The rare condition is caused by the immune system over-reacting to a trigger like a mild infection or medication, leading to blistering and peeling of the skin and surfaces of the eyes, mouth and throat.
Sometimes called toxic epidermal necrolysis, it needs to be treated immediately in hospital.
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Doctors examining the woman observed that she had conjunctivitis and discharge leaking out of her eyes, blisters across her face and a yellowish gunk coating her swollen lips.
A rash resembling targets – with a purple or dark area of skin surrounded by a lighter area – also covered her arms and legs.
Though in “distress”, the woman appeared fully conscious and tests to asses her heart health and breathing were “unremarkable”.
Doctors also conducted a chest X-ray, blood tests and a skin biopsy – the latter confirmed their suspicions that she was suffering from SJS.
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The 45-year-old was admitted in the hospital’s intensive care unit, where she was put on an IV drip and given a seven day course of antibiotics and eye drops.
She also had a tube inserted down her throat to administer fluids and had the lesions around her mouth treated with mouthwashes and topical anaesthetics.
“After seven days of admission, the patient’s condition showed significant improvement, prompting her discharge for regular follow-up with a dermatologist, ophthalmologist, and internist,” doctors wrote.
Her facial rash and ulcers decreased significantly in the two months following her admission.
“Continuing follow-up appointments with the specialists was crucial to monitor her progress closely and ensure her ongoing recovery,” doctors added.
Ibuprofen is widely used and “generally regarded as safe for pain relief and inflammation”, they wrote.
What are the symptoms of Stevens–Johnson Syndrome (SJS)?
STEVENS-Johnson syndrome is a rare condition caused by an ‘over-reaction’ of the immune system to a mild infection or medicine.
It leads to blistering and peeling of the skin and surfaces of the eyes, mouth and throat.
Common drug triggers include:
- Epilepsy medicines
- Antibiotics
- Anti-inflammatory painkillers like ibuprofen
In children, Stevens-Johnson syndrome can sometimes be caused by infections like cold or flu, cold sores and glandular fever.
Stevens-Johnson syndrome can start with flu-like symptoms, such as a high temperature, sore throat, cough and joint pain.
A skin rash appears a few days later, starting on the upper body and before quickly spreading to the face, arms, legs and other areas of the body, such as the genitals.
Affected patches may look like a ‘target’ with a purple or dark area of skin surrounded by a lighter area.
Initially, the skin may be discoloured but then blisters develop which burst and leave sore areas.
The mucous membranes – moist areas of tissue such as the eye, inside of the mouth and throat – are also affected with blisters and ulceration.
As swallowing can become painful, people can be prone to dehydration.
If the surface of the eye is affected, this could lead to long term damage if not treated promptly.
It may take several weeks or months for you to fully recover from Stevens-Johnson syndrome.
And it can cause serious complications, including:
- Skin problems like a skin infection, changes in skin colour and scarring
- Problems with organs, such as the lungs, liver and kidneys
- Eye problems, such as long-term inflammation or sight problems
- Problems with the vagina or penis caused by scarring
You’re more likely to get Stevens-Johnson syndrome if:
- You’ve had it before after taking a certain medicine
- You have a weakened immune system – for example, from having a condition like HIV or AIDS, or treatments like chemotherapy
- A close family member has had Stevens-Johnson syndrome
Sources: NHS, Great Ormond Street Hospital
Yet the woman’s rare case highlights the “potential peril” of a severe reaction like SJS caused by the “seemingly innocuous act of reaching for an over-the-counter pain reliever”.
“SJS is more commonly linked to certain infections and other medications, such as antibiotics and anticonvulsants (epilepsy medicines), yet documented cases associated with ibuprofen use have been reported,” doctors went on.
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The case “underscores the importance of vigilance, both on the part of healthcare providers and on the public, in recognising potential adverse reactions”, they stated.
“Healthcare providers should exercise caution when prescribing ibuprofen, particularly in patients with a history of adverse drug reactions,” doctors involved in the woman’s care advised.
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Eliza Loukou
