Stevens-Johnson syndrome induced by gabapentin and cilostazol in diabetic patient co-infected with COVID-19


  • I. Kadek Aditya Nugraha Department of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia
  • Ketut Suryana Department of Pulmonology and Respiratory Medicine Wangaya Regional Hospital, Denpasar, Bali, Indonesia
  • Dewi Catur Wulandari Department of Internal Medicine, Wangaya Regional Hospital, Denpasar, Bali, Indonesia
  • Tjokorda Dalem Pemayun Department of Dermatology and Venereology, Wangaya Regional Hospital, Denpasar, Bali, Indonesia



SJS, COVID-19, Gabapentin, Cilostazol


Coronavirus disease 2019 (COVID-19) has been declared as an emergent pandemic. COVID-19 mainly present with fever and respiratory symptoms. Its severity ranges from asymptomatic infection, mild, moderate, severe to critical degrees which is related to the degree of dysregulated inflammatory response and systemic inflammation. Stevens-Johnson syndrome (SJS), on the other hand is a rare, severe, type IV hypersensitivity presenting with epithelial destruction of skin and mucous membranes. This condition also associated with systemic proinflammatory state. We report a case of a 73-years-old woman with dry cough and fever, who recently started treatment with cilostazol and gabapentin, then followed by redness and blistering on her lips, trunk, and genital which subsequently diagnosed with COVID-19 and SJS.


WHO. WHO Coronavirus (COVID-19) Dashboard, 2021. Available at: Accessed on 11 March 2021.

Li G, Fan Y, Lai Y, Han T, Li Z, Zhou P, et al. Coronavirus infections and immune responses. J Med Virol. 2020;92(4):424-32.

Chung WH, Hung SI. Recent advances in the genetics and immunology of Stevens-Johnson syndrome and toxic epidermal necrosis. J Dermatol Sci. 2012;66(3):190-6.

Hsu DY, Brieva J, Silverberg NB, Silverberg JI. Morbidity and Mortality of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in United States Adults. J Invest Dermatol. 2016;136(7):1387-97.

Mortaz E, Tabarsi P, Varahram M, Folkerts G, Adcock IM. The Immune Response and Immunopathology of COVID-19. Front Immunol. 2020;11:2037.

Feng X, Li S, Sun Q, Zhu J, Chen B, Xiong M, Cao G. Immune-Inflammatory Parameters in COVID-19 Cases: A Systematic Review and Meta-Analysis. Front Med. 2020;7:301.

Biasi S, Meschiari M, Gibellini L, Bellinazzi C, Borella R, Fidanza L, et al. Marked T cell activation, senescence, exhaustion and skewing towards TH17 in patients with COVID-19 pneumonia. Nat Commun. 2020;11(1):3434.

Chen Z, John Wherry E. T cell responses in patients with COVID-19. Nat Rev Immunol. 2020;20(9):529-36.

Roujeau JC. The spectrum of Stevens-Johnson syndrome and toxic epidermal necrolysis: a clinical classification. J Invest Dermatol. 1994;102(6):28-30.

Mockenhaupt M. Epidermal Necrolysis (Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis). In: Kang S, Bruckner AL, Enk AH, Margolis DJ, Orringer JS, eds Fitzpatrick’s Dermatology. 9th ed. New York, NY: McGraw-Hill; 2019: 733-748.

Borrelli EP, Lee EY, Descoteaux AM, Kogut SJ, Caffrey AR. Stevens-Johnson syndrome and toxic epidermal necrolysis with antiepileptic drugs: An analysis of the US Food and Drug Administration Adverse Event Reporting System. Epilepsia. 2018;59(12):2318-24.

Kang SY, Kim JY, Kim MY, Lee SY, Kim MH, Kim TW, et al. Drug-induced hypersensitivity syndrome/drug reaction with eosinophilia and systemic symptoms syndrome induced by cilostazol and carbamazepine. J Dermatol. 2012;39(8):723-4.

Su SC, Chung WH. Update on pathobiology in Stevens-Johnson syndrome and toxic epidermal necrolysis. Dermatologica Sin. 2013;31(4):175-80.

Recovery Collaborative Group, Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384(8):693-704.






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