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Adverse drug reactions
Terbinafine-induced Steven-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) overlap
  1. Biswajit Banik1,
  2. Debarati Bhar1,
  3. Abheek Sil2
  1. 1 Internal Medicine, R.G. Kar Medical College and Hospital, Kolkata, India
  2. 2 Dermatology, Venereology, and Leprosy, R.G. Kar Medical College and Hospital, Kolkata, India
  1. Correspondence to Abheek Sil, Department of Dermatology, Venereology, and Leprosy, R.G. Kar Medical College, 1, Khudiram Bose Sarani, Kolkata 700004, West Bengal, India; abheek.sil{at}gmail.com

http://dx.doi.org/10.1136/postgradmedj-2020-138326

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    Terbinafine is a lipophilic allylamine compound that inhibits the biosynthesis of ergosterol, the principal fungal sterol, at the level of squalene epoxidase. It is a widely used antifungal agent owing to its efficacy, safety profile and fewer drug interactions. Adverse cutaneous reactions (pruritus, rash, urticaria, pustular eruptions, erythema multiforme, cutaneous lupus, psoriasis, Baboon syndrome and pityriasis rosea) are encountered in only 2% of patients.1 Here, we describe a rarely reported but potentially fatal complication, Steven-Johnson syndrome and toxic epidermal necrolysis overlap (SJS/TEN) attributed to this commonly prescribed antimycotic drug.

    An 36-year-old normotensive, non-diabetic woman, newly diagnosed with toenail onychomycosis by her physician, was started on tablet terbinafine 250 mg one time per day (12-week course). A week later, she developed fever, stinging eyes and pain upon swallowing. Tender skin lesions, which appeared first on the trunk, spread rapidly to …

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    Footnotes

    • Contributors AS contributed to conception, initial drafting of the manuscript; critical revision of content and final approval of the manuscript. BB and DB contributed to conception, critical revision of content and final approval of the manuscript. All authors are in agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication All the authors consented to publish this manuscript. Informed consent and releases from the patient was taken.

    • Provenance and peer review Not commissioned; externally peer reviewed.