Objective: Stevens–Johnson syndrome (SJS) is an acute hypersensitivity reaction that compromises the integrity of mucous membranes and cutaneous tissue. Chronic lymphocytic leukemia(CLL) is a chronic B-lymphoproliferative neoplasm that is one of the most often appearances in daily hematological practice. The CD20 antigen is an attractive target in CLL as it is present on the surface of mature B-cells. Rituximab is a highly specific chimeric mouse/human anti-CD20 antibody that is widely used in the treatment of CLL and other B-lymphomas. The aim of this abstract is to describe the occurrence of Stevens-Johnson syndrome as a result of the administration of Rituximab to a patient with CLL

Case report: We report the case of a 49 years old caucasian male that four years previously was diagnosed with CLL stage A Binet. The “watch and wait” strategy was adopted at that time. But the patient disappeared from the current supervision of the hematologist and returned after 4 years with B symptoms, giant splenomegaly, hepatomegaly, peripheral lymphadenopathy, and bicytopenia (anemia and thrombocytopenia) that accompanied the lymphocytosis in peripheral blood. Stage C Binet was established, and for this patient was proposed the initiation of treatment with chemoimmunotherapy type FCR according to guidelines. But, the patient refused to administer any type of chemotherapy and in the absence of new targeted therapeutic alternatives, the most plausible solution was to initiate monotherapy with Rituximab 375mg/m2 weekly. On the 3rd day after the second administration of rituximab, he experienced a febrile episode 38.5°C, fatigue, and weakness, moderate pain all over the skin, which were aggravated by a slight touch and a non-pruritic widespread maculopapular rash, which affects the oral mucosa and also the skin in the genital area, palmar and plantar region. SJS was diagnosed affecting 12% of total body surface area according to the Lund-Browder Burn calculator. Rituximab therapy was stopped and immediate treatment of SJS has started. Patients received supportive care measures including hydration, wound debridement, systemic and topical antibiotics, topical and systemic corticosteroids, nutritional support, and pain management for 4 weeks with a total recovery of skin and mucosal lesions.

Conclusion: Although SJS is a rare complication of Rituximab therapy (0.01% in a series of 167,000 patients), it remains a dreaded complication with a 30% mortality rate among patients who develop it. Recognition of clinical signs and prompt diagnosis along with complex therapy can ensure adequate recovery of the case.