A case published in JAMA Dermatology reports on a newborn with congenital toxoplasmosis who was safely and successfully treated with agents that caused Stevens-Johnson syndrome (SJS) in the mother.
At 33 weeks gestation, the 35-year-old woman was given pyrimethamine and sulfadiazine 5 weeks after being diagnosed with toxoplasmosis seroconversion. An analysis of the amniotic fluid also confirmed congenital toxoplasmosis. Two weeks after starting treatment, she presented to the emergency department with skin and mucous membrane lesions; the patient denied taking any other drugs. An erythematous eruption covering 8% of the body surface area (BSA) and detachment affecting 5% of BSA were discovered in addition to hemorrhagic erosions on the eyes, mouth, and genital mucous membranes.
Pyrimethamine and sulfadiazine were both subsequently stopped. A skin biopsy revealed “full-thickness epidermal necrosis with subepidermal separation, consistent with SJS.” Due to the rapid spread of disease, the newborn was delivered via cesarean section; the child was healthy without signs of SJS or toxic epidermal necrolysis (TEN). Due to the lack of data regarding effective second-line treatments, a decision was made to treat the newborn’s congenital toxoplasmosis with the same agents that induced SJS in the mother.
During the first year of treatment, the infant did not experience any signs of SJS or TEN. The mother also recovered and was healthy 2 years later without complications. “The absence of newborn involvement despite exposure to the mother’s SJS causative drugs may suggest that critical factors mediating SJS and TEN in the mother do not pass onto the neonates,” the authors explained. “Nevertheless, the balance of risk and alternatives should always be considered in such cases.”
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