Laxman G, S.K. Meshram, S.G. Dhawane, V.N. Ambade, P.G. Dixit (2015) Medicolegal Consequences of Death due to Stevens Johnson Syndrome: A Case Report. Int J Forensic Sci Pathol. 3(5), 123-126 123 http://scidoc.org/IJFP.php International Journal of Forensic Science & Pathology (IJFP) ISSN 2332-287X Medicolegal Consequences of Death due to Stevens Johnson Syndrome: A Case Report Case Report Laxman G 1* , S.K.Meshram 2 , S.G,Dhawane 2 , V.N.Ambade 2 , P.G.Dixit 3 1 Resident Doctor, Department of Forensic medicine, Govt. Medical College and Hospital, Nagpur, India. 2 Associate Professor, Department of Forensic medicine, Govt. Medical College and Hospital, Nagpur, India. 3 Professor and Head, Department of Forensic medicine, Govt. Medical College and Hospital, Nagpur, India. *Corresponding Author: Laxman GangadharPhad, Resident Doctor, Department of Forensic medicine, Govt. Medical Col- lege and Hospital, Room no15, New PG Hostel, Nagpur - 440003, India. Tel: 9421381771/8805523842 E-mail: laxmanphad87@gmail.com Received: March 14, 2015 Accepted: April 30, 2015 Published: May 12, 2015 Citation: Laxman G, S.K. Meshram, S.G. Dhawane, V.N. Ambade, P.G. Dixit (2015) Medicolegal Consequences of Death due to Stevens John- son Syndrome: A Case Report. Int J Forensic Sci Pathol. 3(5), 123-126. Copyright: Laxman G © 2015. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited. Introduction Stevens Johnson syndrome (SJS) has a potential to cause severe morbidity and mortality, having incidence of 1-6 cases per million person years [1]. It was irstly described in 1922 by A.M. Stevens and Frank C. Johnson in pediatric population. It is idiosyncratic immune complex mediated hypersensitivity reaction and fatal form of erythema multiforme. There is symptomatic involvement of skin and mucous membrane of oral, nasal, ocular, vaginal, ure- thral, gastrointestinal and respiratory tract. There is no reliable test exists to establish a link between a particu- lar drug and SJS in an individual case [2]. Determining the causa- tive drug is based on the time interval between the use of drug and the beginning of the skin reaction. Typically the symptoms of drug-induced SJS arise within a week of starting the medication [3]. People with systemic lupus erythematous or HIV infections are more susceptible to drug-induced SJS [3]. The second most common cause of SJS is infection, but the routine use of medi- cines such as antibiotics, antipyretics and analgesics to manage in- fections make it dificult to determine, whether the events started by infection or medicines taken [4]. The pathogenesis of SJS is multifactorial and is probably due to a dynamic interplay between acquired and constitutional factors in the presence of threshold amount of the drug or its metabolites. Inability to detoxify the intermediate drug metabolites which may serve as haptens when complexes with host epithelial tissue could initiate an immune reaction. Once initiated various triggers prop- agate the immune response leading to keratinocyte apoptosis, a wide variety of causative drugs have been identiied and these are related to the spectrum of local disease and local prescribing practices [5]. SJS is strongly associated with HLA-B*1502 (HLA- B75), an HLA-B serotype of the broader serotype HLA-B15 [6, 7]. A study in Europe suggested the gene marker is only relevant for East Asians [8]. Case Report A 16 year old unmarried girl was brought for postmortem ex- amination in forensic medicine dept. GMCH Nagpur. The details of case were collected from police investigation records, relatives and hospital treatment records. She had complaints of fever and seizures on day 1. Relatives tak- en her to nearby private hospital; physician started the treatment with paracetamol and phenytoin. Then she starts to develop fe- ver, cough, and rashes from day 2 onwards. But treating physician continued the treatment, he neither taken consultation of other expert (dermatologist) nor discontinued the treatment, but still assured the relatives regarding the cure of patient. By the time, Rashes gradually started to progress on face and upper chest, Abstract Conditions like Stevens Johnson syndrome are very rare and mortality arising out of it is still a rarest entity. It is immune complex mediated hypersensitivity reaction; most common factors to trigger the immunity are drugs, followed by infection with various organisms, which starts the chain of events in SJS. It sometimes associated with HLA Antigen and 25-50% cases are idiopathic. In present case an emphasis is given on progression of this life threatening condition, mode of death, responsibilities of the physician and legal as well as criminal consequences arise out of it while treating such cases. Keywords: Stevens Johnson Syndrome; Hypersensitivity Reaction; Erythema Multiforme.