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A Stevens-Johnson syndrome due to rifampicin in a patient with acquired immune deficiency syndrome (AIDS) and pulmonary tuberculosis

  • Aiza Dwitri Aninditya ,
  • Ari Baskoro ,


Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially fatal hypersensitivity reactions that can be drug-induced, especially in patients with AIDS. This report aims to highlight the diagnosis and management of a patient with acquired immunodeficiency syndrome (AIDS) that consumed multiple drugs including anti-tuberculosis drugs that develop SJS.

Case presentation: A 30-year-old male patient with AIDS administered with chief complaints of burning sensation all over the bodies and erythematous macules scattered across the stomach and back, followed by blisters distributed across the chest, back, face, lips, hands and feet, as well as genitals for 3 days. Patient was diagnosed with AIDS and under ARV medication since about 5 years ago and dan cotrimoxazole for 9 months. Couple months before admission, patient was diagnosed with tuberculosis and under anti-tuberculosis treatment (isoniazid, rifampicin, pyrazinamide, and ethambutol (HRZE)) but stopped due to drug-induced hepatitis (DIH) which then changed to another regiment (streptomycin, levofloxacin, and ethambutol (SLE)) followed by another regiment (rifampicin, isoniazid and ethambutol (RHE)). The patient diagnosed with drug-induced SJS, however, in order to find out the SJS drugs inducer, an algorithm for assessment of drug causality in Stevens-Johnson Syndrome and toxic epidermal necrolysis (ALDEN) score as causality assessments tool was applied and rifampicin decided to be the precursor. The patient was managed for 13 days prior to discharge with improved condition.

Conclusion: Diagnosing process for drug-induced in patient with AIDS, in addition to multiple drugs consumption, is a challenge. A multidisciplinary approach and appropriate causality assessments tool should be considered before administering further management and medications.


  1. Citra BD, Masri R. STEVENS JOHNSON SYNDROME PADA PASIEN HIV. Hum Care J. 2020;5(2):545. Available from:
  2. Samson NM, Awalia. An Indonesian female with Stevens-Johnson syndrome mimicking cutaneous lupus: A case report. Ann Med Surg. 2022;82:104644. Available from:
  3. Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39. Available from:
  4. Tseng J, Maurer T, Mutizwa MM. HIV-Associated Toxic Epidermal Necrolysis at San Francisco General Hospital. J Int Assoc Provid AIDS Care. 2016;16(1):37–41. Available from:
  5. Queena Maureen Wijanto J, Damayanti D, Fathul Qorib M, Anggraeni S, Rosita Sigit Prakoeswa C. Risk Factors for Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) in Dr. Soetomo General Hospital Surabaya. Int J Res Publ. 2021;92(1). Available from:
  6. Suwarsa O, Yuwita W, Dharmadji HP, Sutedja E. Stevens-Johnson syndrome and toxic epidermal necrolysis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2009-2013. Asia Pac Allergy. 2016/01/27. 2016;6(1):43–7. Available from:
  7. Mittmann N, Knowles SR, Koo M, Shear NH, Rachlis A, Rourke SB. Incidence of Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome in an HIV Cohort. Am J Clin Dermatol. 2012;13(1):49–54. Available from:
  8. Fritsch PO, Sidoroff A. Drug-Induced Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Am J Clin Dermatol. 2000;1(6):349–60. Available from:
  9. Suniti S, Sufiawati I. Herbal-induced Stevens-Johnson syndrome with oral involvement and management in an HIV patient. Dent J (Majalah Kedokt Gigi). 2018;51(3):153. Available from:
  10. Prakoeswa CRS, Sasmito EH, Denissafitri A, Umborowati MA, Anggraeni S. Stevens-Johnson Syndrome induced by Piroxicam: A Case Report. Indian J Forensic Med & Toxicol. 2022;16(4). Available from:
  11. Putranti IO, Primanita C, Fawzy A. P The Role of Debridement in the Management of Toxic Epidermal Necrolysis in Inpatients at Prof. Dr. Margono Soekarjo Year 2005-2015: Retrospective Study. 2019;45(3). Available from:
  12. Chateau A V, Dlova NC, Dawood H, Aldous C. Outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in HIV-infected patients when using systemic steroids and/or intravenous immunoglobulins in Pietermaritzburg, South Africa. South Afr J HIV Med. 2019;20(1):944. Available from:
  13. Isaac WA, Damayanti D, Fatimah N, Hidayati AN. The Profiles of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Patients in Tertiary Hospital. Berk Ilmu Kesehat Kulit dan Kelamin. 2021;33(2):116. Available from:
  14. Kim H-I, Kim S-W, Park G-Y, Kwon E-G, Kim H-H, Jeong J-Y, et al. Causes and treatment outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in 82 adult patients. Korean J Intern Med. 2012/05/31. 2012;27(2):203–10. Available from:
  15. Abdulah R, Suwandiman TF, Handayani N, Destiani DP, Suwantika AA, Barliana MI, et al. Incidence, causative drugs, and economic consequences of drug-induced SJS, TEN, and SJS-TEN overlap and potential drug-drug interactions during treatment: a retrospective analysis at an Indonesian referral hospital. Ther Clin Risk Manag. 2017;13:919–25. Available from:
  16. Nugroho NP, Kusmiati T. Allergic Reaction due to Anti-Tuberculosis Drugs, How to Manage? J Respirasi. 2021;7(2):79. Available from:
  17. Badar V, Mishra D, Deshmukh S, Chaudhari S. A case of Stevens-Johnson syndrome due to rifampicin. Int J Basic & Clin Pharmacol. 2014;3(1):239. Available from:
  18. Goldman JL, Chung W-H, Lee BR, Chen C-B, Lu C-W, Hoetzenecker W, et al. Adverse drug reaction causality assessment tools for drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: room for improvement. Eur J Clin Pharmacol. 2019/03/27. 2019;75(8):1135–41. Available from:
  19. Shiga S, Cartotto R. What Are the Fluid Requirements in Toxic Epidermal Necrolysis? J Burn Care & Res. 2010;31(1):100–4. Available from:
  20. Mockenhaupt M. Stevens-John syndrome and toxic epidermal necrolysis: clinical patterns, diagnostic considerations, etiology, and therapeutic management. Semin Cutan Med Surg. 2014;33(1):10–6. Available from:
  21. Ho Y-L, Chang Y-T, Chu Y-T, Wu S-C. Performance of the SCORTEN in Taiwanese patients with Stevens-Johnson syndrome and toxic epidermal necrolysis. Dermatologica Sin. 2010;28(1):15–20. Available from:

How to Cite

Aninditya, A. D., & Baskoro, A. . (2023). A Stevens-Johnson syndrome due to rifampicin in a patient with acquired immune deficiency syndrome (AIDS) and pulmonary tuberculosis . Bali Medical Journal, 12(2), 1533–1537.




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