www.ijbcp.com International Journal of Basic & Clinical Pharmacology | May-June 2016 | Vol 5 | Issue 3 Page 1140 IJBCP International Journal of Basic & Clinical Pharmacology Print ISSN: 2319-2003 | Online ISSN: 2279-0780 Case Report Amoxycillin and clavulanic acid induced Stevens-Johnson syndrome: a case report Ravi Shankar Manchukonda*, Chandrakantha Thippeswamy, Neha Krishnegowda, Narasimhamurthy Kalenahally Muthahanumaiah INTRODUCTION Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Although several classification schemes have been reported, the simplest classification breaks the disease down as follows;  Stevens-Johnson syndrome; a minor form of toxic epidermal necrolysis, with less than 10% body surface area (BSA) detachment  Overlapping Stevens-Johnson syndrome/toxic epidermal necrolysis; detachment of 10-30% of the BSA  Toxic epidermal necrolysis; detachment of more than 30% of the BSA. While minor presentations may occur, significant involvement of oral, nasal, eye, vaginal, urethral, gastrointestinal, and lower respiratory tract mucous membranes may develop in the course of the illness. GI and respiratory involvement may progress to necrosis. Stevens-Johnson syndrome is a serious systemic disorder with the potential for severe morbidity and even death. 2 ABSTRACT Stevens-Johnson syndrome (SJS) is an immune complex mediated hypersensitivity complex that typically involves the skin and the mucous membranes. Various etiologic factors (e.g., infection, drugs and malignancies) have been implicated as causes of Stevens-Johnson syndrome. However, as many as half of the cases are idiopathic. Bastuji and Roujeau proposed that the denomination of Stevens-Johnson syndrome should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that arise on erythematous or purpuric maculae that are different from classic targets. In this case report, a 6 year old girl who was administered a cough syrup (containing bromhexine, guaiphenesin, diphenhydramine and phenylephrine) and amoxycillin and clavulanic acid dispersible tablet for the treatment of cough developed pruritic skin eruptions all over the body along with painful erosions on the tongue, buccal mucosa, genital and anal mucosa. A diagnosis of Stevens- Johnson syndrome was made. Amoxycillin and clavulanic acid combination was identified as the culprit based on the temporal relationship between the drug administration and the appearance of the rashes and based on a number of SJS reports implicating amoxycillin and clavulanic acid having been published before. The cough syrup and amoxycillin and clavulanic acid combination tablets were immediately stopped. Symptomatic treatment was administered. The child improved and was later discharged. Causality assessment using Naranjo adverse drug reaction probability scale revealed that amoxycillin and clavulanic acid combination was a possible cause for the harmful cutaneous adverse reaction with a score of 4. Keywords: Stevens-Johnson syndrome, Amoxycillin and clavulanic acid, Bromhexine, Guaiphenesin, Diphenhydramine, Phenylephrine, Mucous membrane erosions, Erythematous macules, Purpuric macules, Blisters, Naranjo Adverse Drug Reaction Probability scale DOI: http://dx.doi.org/10.18203/2319-2003.ijbcp20161584 Department of Pharmacology, Adichunchanagiri Institute of Medical Sciences, B.G. Nagar, Karnataka, India Received: 07 March 2016 Accepted: 08 April 2016 *Correspondence to: Dr. Ravi Shankar Manchukonda, Email: ravipharmac @yahoo.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open- access article distributed under the terms of the Creative Commons Attribution Non- Commercial License, which permits unrestricted non- commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.