Case Report DOI: 10.7241/ourd.20144.96 www.odermatol.com Cite this article: Raj RT, Kaur B, Lochan KK, Bahl RK. Nimesulide induced Stevens Johnson syndrome (SJS); managed successfully with combined approach of steroids, intravenous immunoglobulin and placentrex gel: A case report. Our Dermatol Online. 2014; 5(4): 384-387. NIMESULIDE INDUCED STEVENS JOHNSON SYNDROME (SJS); MANAGED SUCCESSFULLY WITH COMBINED APPROACH OF STEROIDS, INTRAVENOUS IMMUNOGLOBULIN AND PLACENTREX GEL: A CASE REPORT Rakesh Tilak Raj 1 , Baljinder Kaur 2 , Krishan Kumar Lochan 2 , Rakesh Kumar Bahl 1 1 Department of Dermatology, Venereology and Leprosy, Government Medical College, Patiala (Punjab), India 2 Department of Paediatrics, Government Medical College and Hospital, Patiala (Punjab), India Corresponding author: Dr Rakesh Tilak Raj rakeshtraj2012@gmail.com Introduction Stevens-Johnson syndrome (SJS) is a rare and life threatening form of severe cutaneous adverse drug reaction (SCAR) having an unpredictable lethal course in 5-15 % of the cases [1]. The pathogenesis of SJS is unclear and there is no universally accepted deinition, but the presence of mucosal involvement and percentage of total body surface area (TBSA) affected can help in classiication. Limited skin detachment i.e. epidermolysis (<10% of TBSA) favors SJS whereas widespread involvement (>30%) points towards (TEN) toxic epidermal necrolysis while intermediate cases labeled as SJS/TEN overlap according to Bastuji-Garin et al. [2]. Various etiological factors have been proposed regarding SJS but drugs are the most common cause. Levi et al. conirmed that four groups of drugs were highly suspectable to cause SJS in children < 15 years of age: sulfonamide, phenobarbitone, carbamazepine and lamotrigine [3]. The incidence of SJS in western literature was reported between 1.2-6% cases per million per year and women were more frequently affected than men [4]. Source of Support: Nil Competing Interests: None Our Dermatol Online. 2014; 5(4): 384-387 Date of submission: 09.07.2014 / acceptance: 13.09.2014 Abstract There is a high mortality rate in Stevens Johnson Syndrome (SJS) and it ranges between 5%-15%. At present, there is no deinite consensus regarding treatment in SJS although the effectiveness of intravenous immunoglobulin’s (IVIg) and immunosuppressive like cyclosporine have generated new hopes in the lives of these patients. But the options of combination therapy of steroids, IVIg and Placentrex gel have not been fully exercised in SJS. Henceforth, we report a case of Nimesulide induced SJS; managed successfully with a combined approach without any recurrence during a 12 months follow-up. Key words: Severe Cutaneous adverse drug reactions (SCAR); Placentrex; Corticosteroids; Immunoglobulin’s; SCORTEN Index; Naranjo’s ADR probability Scale What is known? · SJS is a fatal, life threatening condition of drug therapy. · Standardized guidelines regarding treatment are lacking. · Steroids have a controversial role? · Different institutions from different countries are adopting different treatment regimens. 384 © Our Dermatol Online 4.2014