Fluconazole-associated Stevens-Johnson syndrome following single-dose use in an HIV-negative patient

Abstract

We describe a case of fluconazole-associated Stevens-Johnson syndrome (SJS) in a healthy, young woman following single-dose treatment for presumed vaginal candidiasis. After several ambulatory consultations, she was hospitalized with worsening dysphagia, odynophagia, conjunctivitis, mucosal ulcers and reduced oral intake. Over her two-week stay, cutaneous and mucosal involvement worsened, with esophageal lesions identified on endoscopy. Investigations did not reveal an alternative cause for her presentation, and subspecialty consultants supported the diagnosis of fluconazole-associated SJS. She required parenteral nutrition and analgesia for six days in hospital before discharge. We provide a review of the literature on all cases of fluconazole-associated SJS and toxic epidermal necrolysis (TEN), and apply the Naranjo probability scale for drug-induced adverse reaction to each case. Given the wide availability of fluconazole, this is a rarely reported adverse reaction with only 13 other case reports rated as ‘probable’ and only two other cases following a single dose exposure.