{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T14:08:31Z","timestamp":1789654111527,"version":"4.0.0"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Pharm Health Care Sci"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) represent life-threatening mucocutaneous reactions, predominantly triggered by medications. This case report presents a rare instance of SJS-TEN overlap in a young Indian female precipitated by the combined use of fluoroquinolone (ofloxacin), cephalosporin (cefixime), and paracetamol\u2014an uncommon drug triad not widely reported in existing literature. The case highlights the importance of early diagnosis, thorough drug history evaluation, and the challenges of managing polypharmacy-induced severe cutaneous adverse reactions (SCARs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>A 29-year-old Indian female developed widespread dusky purpuric plaques, mucosal erosions (oral, genital, conjunctival, nasal), and bullae six days after local consultation with ofloxacin, cefixime, paracetamol, and other symptomatic agents. She presented to the emergency department with painful vesiculobullous eruptions involving\u2009&gt;\u200910% body surface area, mucosal ulcerations, eye involvement with crusting, and systemic symptoms including fever, vomiting, and urinary discomfort. Laboratory investigations revealed anemia, elevated RDW, and positive ketones in urine. Diagnosis of SJS-TEN overlap was made clinically. The patient was managed with a multi-disciplinary approach involving systemic corticosteroids (IV dexamethasone), hydration, antibiotics (azithromycin), antihistamines, electrolyte balance, topical agents, ophthalmic care, and pain management. The extensive yet individualized treatment regimen reflected a robust pharmacovigilance response to avoid further drug-induced complications. Improvement was noted with complete re-epithelialization and symptomatic resolution over two weeks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights the necessity for clinicians to maintain high suspicion for SCARs in patients presenting with mucocutaneous symptoms and recent drug exposure\u2014even with commonly used medications not frequently associated with SJS-TEN. The unique presentation involving synchronous ocular, nasal, oral, and genital erosions alongside use of a rare drug combination strengthens the need for early recognition, comprehensive clinical assessment, and cautious prescription practices. Individualized treatment and close monitoring are crucial in preventing mortality and minimizing complications. This case underscores the importance of pharmacovigilance and personalized care in managing drug-induced hypersensitivity reactions, especially in resource-limited or polypharmacy scenarios.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s40780-025-00488-5","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T13:11:06Z","timestamp":1761916266000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Ofloxacin, paracetamol and cefixime induced Stevens-Johnson syndrome - toxic epidermal necrolysis in an adult female patient: a case report"],"prefix":"10.1186","volume":"11","author":[{"given":"Margi R.","family":"Desai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7341-5483","authenticated-orcid":false,"given":"Harshita","family":"Jaiswal","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mrudangsinh M.","family":"Rathod","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sakshi","family":"Vijayvargi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"issue":"4","key":"488_CR1","first-page":"41874","volume":"50","author":"MK Marzouq","year":"2023","unstructured":"Marzouq MK. Case presentation of stevens\u2019johnson syndrome\/toxic epidermal necrolysis. Biomedical J Sci Tech Res. 2023;50(4):41874\u201380.","journal-title":"Biomedical J Sci Tech Res"},{"key":"488_CR2","doi-asserted-by":"publisher","unstructured":"Racha AS, Ashwani P, Swarnalatha P. Cefditoren pivoxil induced toxic epidermal necrolysis: a case report. Int J Res Dermatol. 2023;9(5):307\u201310. Available from: https:\/\/doi.org\/10.18203\/issn.2455-4529.intjresdermatol20232550","DOI":"10.18203\/issn.2455-4529.intjresdermatol20232550"},{"key":"488_CR3","doi-asserted-by":"publisher","unstructured":"Mukherjee S, Saha D, Dasgupta S, Kumar Tripathi S. Case report: suspected case of Stevens\u2013Johnson syndrome and toxic epidermal necrolysis overlap due to ursodeoxycholic acid. EMJ Dermatol. 2020:96\u20139. Available from: https:\/\/doi.org\/10.33590\/emjdermatol\/20-00117","DOI":"10.33590\/emjdermatol\/20-00117"},{"issue":"6","key":"488_CR4","doi-asserted-by":"publisher","first-page":"891","DOI":"10.1007\/s40257-024-00889-6","volume":"25","author":"H Shah","year":"2024","unstructured":"Shah H, Parisi R, Mukherjee E, Phillips EJ, Dodiuk-Gad RP. Update on Stevens-Johnson syndrome and toxic epidermal necrolysis: diagnosis and management. Am J Clin Dermatol. 2024;25(6):891\u2013908. https:\/\/doi.org\/10.1007\/s40257-024-00889-6","journal-title":"Am J Clin Dermatol"},{"key":"488_CR5","doi-asserted-by":"publisher","unstructured":"Neagu TP, Tiglis M, Peride I, Niculae A. Toxic epidermal necrolysis, a serious side effect of tenoxicam use: a case report. Healthcare (Basel). 2023;11(15):2195. 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J Am Acad Dermatol. 2019;81(3):749\u201357. https:\/\/doi.org\/10.1016\/j.jaad.2019.05.061","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"488_CR7","doi-asserted-by":"publisher","first-page":"1553","DOI":"10.1016\/j.jaad.2020.02.066","volume":"82","author":"L Seminario-Vidal","year":"2020","unstructured":"Seminario-Vidal L, Kroshinsky D, Malachowski SJ, Sun J, Markova A, Beachkofsky TM, Kaffenberger BH, Ergen EN, Mauskar M, Bridges A, Calhoun C, Cardones AR, Chen ST, Chodosh J, Cotliar J, Davis MDP, DeNiro KL, Dominguez AR, Eljure-T\u00e9llez J, Micheletti RG. Society of dermatology hospitalists supportive care guidelines for the management of Stevens-Johnson syndrome\/toxic epidermal necrolysis in adults. J Am Acad Dermatol. 2020;82(6):1553\u201367. https:\/\/doi.org\/10.1016\/j.jaad.2020.02.066","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"488_CR8","doi-asserted-by":"publisher","first-page":"131","DOI":"10.4065\/mcp.2009.0379","volume":"85","author":"D Wetter","year":"2010","unstructured":"Wetter DA, Camilleri MJ. Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic. Mayo Clin Proc. Mayo Clinic. 2010;85(2):131\u20138 https:\/\/doi.org\/10.4065\/mcp.2009.0379","journal-title":"Mayo Clin Proc"},{"key":"488_CR9","doi-asserted-by":"publisher","unstructured":"Dobry AS, Himed S, Waters M, Kaffenberger BH. Scoring assessments in Stevens-Johnson syndrome and toxic epidermal necrolysis. Front Med (Lausanne). 2022;9:883121. Available from: https:\/\/doi.org\/10.3389\/fmed.2022.883121","DOI":"10.3389\/fmed.2022.883121"},{"key":"488_CR10","doi-asserted-by":"publisher","unstructured":"Koh HK, Fook-Chong SMC, Lee HY. 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