Stevens–Johnson syndrome secondary to oseltamivir (Tamiflu®)

We write to highlight a serious cutaneous side effect of the drug oseltamivir or Tamiflu® which has recently been in widespread use due to the swine influenza epidemic.

A 17-year-old male presented to hospital with an erythematous rash over his limbs and trunk, oral ulceration, facial swelling, and blurred vision. He was well with no significant past medical history. Two weeks previously he had experienced a viral illness of headache, fever, and myalgia which was treated with oseltamivir (Tamiflu®) in the community. The day after completing the course he developed these symptoms. Other than paracetamol he had taken no other medication. Stevens–Johnson syndrome secondary to oseltamivir was diagnosed. He was found to have corneal ulceration requiring steroid eye drops and required admission and other supportive treatment before eventually recovering several weeks later.

Stevens–Johnson syndrome is a rare but recognised complication of oseltamivir (Tamiflu®) and the condition does have an associated mortality. To date there are no figures regarding adverse reactions of this nature, as most information comes from small previous studies.¹ The most common events recorded are nausea and vomiting. A Cochrane Review showed that oseltamivir (Tamiflu®) slightly reduces time to alleviation of symptoms and is of use as post-exposure prophylaxis, but concludes low effectiveness.² There have been recent calls for caution in extensive use of this drug as these serious side effects become more apparent. Given the sometimes minimal benefits, it may be advisable to think twice before issuing a prescription; however, with increasing use, we are likely to see more cases of severe skin reactions in the future.