Terbinafine-induced Steven-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) overlap

Abstract

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 …