Stevens-Johnson syndrome/toxic epidermal necrolysis: treatment with low-dose corticosteroids, vitamin C and thiamine

BMJ Case Rep. 2019 Nov 2;12(11):e230538. doi: 10.1136/bcr-2019-230538.


We present the case of a 33-year-old woman with no significant past medical history who was admitted to an outside hospital for the abrupt onset of fevers, malaise and a diffuse mucocutaneous rash. Her constellation of symptoms and presentation were most consistent with a diagnosis of Stevens-Johnson syndrome/toxic epidermal necrolysis overlap syndrome secondary to ibuprofen exposure. Her rash continued to worsen and she was transferred to our medical intensive care unit (ICU), where broad-spectrum antibiotics were discontinued and she was treated with supportive care as well as 'low-dose' intravenous hydrocortisone, ascorbic acid (vitamin C) and thiamine (HAT therapy). After starting this therapy, the patient demonstrated a dramatic response with rapid improvement of her cutaneous and mucosal lesions. She was tolerating a diet provided by the hospital on day 4 and was discharged from the ICU a few days later.

Keywords: adult intensive care; dermatology; skin.

Publication types

  • Case Reports

MeSH terms

  • Administration, Intravenous
  • Adrenal Cortex Hormones / administration & dosage*
  • Adult
  • Antioxidants / administration & dosage*
  • Ascorbic Acid / administration & dosage*
  • Drug Therapy, Combination
  • Female
  • Humans
  • Ibuprofen / adverse effects
  • Stevens-Johnson Syndrome / diagnosis
  • Stevens-Johnson Syndrome / drug therapy*
  • Stevens-Johnson Syndrome / etiology
  • Thiamine / administration & dosage*
  • Vitamin B Complex / administration & dosage*


  • Adrenal Cortex Hormones
  • Antioxidants
  • Vitamin B Complex
  • Ascorbic Acid
  • Ibuprofen
  • Thiamine