Cascade of Calamity: Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Complicated by Acute Kidney Injury, Heart Failure, and Sepsis – A Case Report of Suspected Ciprofloxacin/Co-trimoxazole Trigger

Background Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a life-threatening drug hypersensitivity reaction primarily affecting the skin and mucous membranes. While systemic involvement is known, the simultaneous onset of severe multi-organ failure is rare and poses a significant management challenge. Case Presentation A 63-year-old female with a history of diabetes and hypertension presented with widespread bullous lesions consistent with SJS/TEN. Her condition developed following a course of ciprofloxacin and co-trimoxazole. Within days of admission, her clinical course was catastrophically complicated by severe acute kidney injury (AKI) requiring renal diet consideration, acute-on-chronic heart failure with a left ventricular ejection fraction of 20%, and sepsis confirmed by a markedly elevated procalcitonin (8.86 ng/mL). Management necessitated ICU admission, high-dose corticosteroids, and intravenous immunoglobulin (IVIG), in addition to supportive care for multi-organ failure. Discussion This case highlights a devastating cascade of immune-mediated injury extending far beyond the skin. The presentation of SJS/TEN with concurrent severe renal and cardiac failure is highly unusual. We discuss the potential overlapping mechanisms of drug-induced hypersensitivity leading to multi-organ damage and the complex clinical decisions involved in managing these competing critical conditions. Conclusion Clinicians must be vigilant for severe, multi-system organ failure in patients with SJS/TEN. This case underscores the potential for a single drug hypersensitivity event to precipitate a catastrophic failure of the dermatologic, renal, and cardiovascular systems, necessitating aggressive, multidisciplinary ICU care.