Drug provocation tests to identify analgesic alternatives for an infant with Stevens-Johnson syndrome caused by ibuprofen-acetaminophen

Abstract

Background: The Stevens-Johnson syndrome is a serious skin reaction to drugs, and it is potentially life-threatening. Its handling involves the strict restriction of the drug involved, as well as of the drugs that are similar or structurally related. Case report: A two-year and eight-month old girl with Stevens-Jonson syndrome that was caused by acetaminophen and ibuprofen. Due to the total restriction of non-steroidal anti-inflammatory drugs, and with the purpose of establishing antipyretic alternatives, an oral provocation test was carried out with the usual dose of oral nimesulide, which was negative for both immediate and late reactions. In order to offer a parenteral alternative, a provocation test was carried out with intravenous dipyrone, with in-hospital monitoring for 48 hours in an administration protocol of 10, 30 and 60 %; one dose per hour, for a total of 400 mg. The provocation test was negative for both immediate and late reactions. Oral nimesulide or parenteral dipyrone were prescribed upon requiring analgesic, anti-inflammatory, or antipyretic medication. Conclusion: At a pediatric age, febrile symptoms are common and controlling them is fundamental; such that if an allergy to non-steroidal anti-inflammatory drugs and acetaminophen is identified in an infant, an affectation on the quality of life will be entailed.