Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but life-threatening skin reactions characterized by extensive epidermal necrosis and sloughing, often triggered by medications and occasionally by infectious agents. Common drugs implicated in the pathogenesis of SJS/TEN include penicillin and sulfonamides, with rare instances associated with muscle relaxants such as cyclobenzaprine. Infrequent, infectious causes of SJS/TEN can include Mycoplasma and cytomegalovirus. In immunocompromised individuals, Aspergillus can lead to various clinical complications, with disseminated and invasive Aspergillosis being the most severe. Critically ill patients with SJS/TEN are particularly susceptible to secondary infections due to compromised skin barrier function. Infections, especially with corticosteroid treatment, frequently contribute to mortality rates in SJS/TEN cases.
Here, we present the case of a 30-year-old male without significant medical history who developed SJS/TEN affecting 80% of his body surface area following self-administered muscle relaxants for an unknown illness. Despite aggressive resuscitative measures, the patient succumbed to septic shock and fulminant disseminated intravascular coagulation and was pronounced deceased.
Autopsy findings revealed invasive/disseminated Aspergillosis characterized by acute necrotizing fungal bronchopneumonia, invasive fungal sinusitis, and lung culture positive for Aspergillus fumigatus complex. Although the exact cause of SJS/TEN cannot be confirmed due to muscle relaxant use, the presence of pan-epidermal necrosis and concurrent invasive-disseminated Aspergillosis during autopsy provides strong anatomical and microscopic evidence for the cause of the patient's death. This case underscores the complexity associated with managing, diagnosing, and establishing the etiology of SJS/TEN, highlighting the potential contribution of invasive fungal infections to mortality in these patients.