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4CPS-154 Stevens–Johnson syndrome in a pregnant woman caused by pyrimethamine and sulfadizine
  1. C Ortí Juan,
  2. A Pérez Plasencia,
  3. A Fayet Pérez,
  4. E Nogué Pujadas,
  5. X Larrea Urtaran,
  6. Q López Noguera,
  7. C Díez Vallejo,
  8. M Bruguera Teixidor,
  9. A Dordà Benito,
  10. R Sacrest Güell
  1. Hospital Universitari Dr Josep Trueta, Pharmacy Department, Girona, Spain


Background and importance Stevens–Johnson syndrome (SJS) is a rare and serious skin drug reaction and the pathogenesis includes genetic factors. If it occurs in pregnant women, both conditions can simultaneously affect the mother and the fetus.

Aim and objectives To determine the contribution of the pharmacist in the treatment of rare side effects of drugs.

Material and methods Small cystic images were identified in a 42-year-old pregnant woman (28+1 weeks) by ultrasonography and neurosonography. A transplacental amniocentesis was offered to rule out infections and Toxoplasma gondii polymerase chain reaction (PCR) in amniotic fluid was positive. The patient began oral treatment with pyrimethamine tablets 50 mg/24 hours, sulfadizine 1500 mg/12 hours and folinic acid 7.5 mg/24 hours orally.

12 days after starting treatment, the pregnant woman attended the emergency department of our hospital due to the appearance of a skin rash on the abdomen and lower extremities, skin irritation and fever, and therefore admission was decided.

Results The patient presented feverish peaks during admission with worsening of the rash and painful laterocervical lymphadenopathy. In addition, she had anaemia, leukopenia, and thrombocytopenia attributed to this treatment. She was suspended from treatment with pyrimethamine and sulfadiazine due to suspected toxicity. The diagnosis was oriented to SJS secondary to pyrimethamine and sulfadiazine. Due to the worsening and the clinical dermatological severity of the patient, after consulting the pharmacist, it was considered necessary to start cyclosporine 120 mg every 12 hours (2 mg/kg/12 hours) intravenously (off-label use). She was finally referred to another hospital due to the worsening of the SJS. During admission, treatment with cyclosporine was not maintained, there was a progressive improvement in the skin lesions, and she was discharged due to a favourable evolution of the skin lesions.

Conclusion and relevance The pharmacist validated the treatments during the patient’s hospital stay and reviewed the interactions and adverse reactions associated with the prescribed treatments, confirming the possible causality of SJS by pyrimethamine and sulfadizine. The pharmacist performed a bibliographic search and the benefit–risk balance of medications in special situations was evaluated. Finally, it should be noted that few cases of SJS have been reported during pregnancy, so the pharmacist notified the Spanish Pharmacovigilance System for Medicinal Products for Human Use.

Conflict of interest No conflict of interest

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