Hiiii geralynsn SJS or Steven Johnson Syndrome can occur with theorotically all drugs at any doses. Its a severe form of allergic kind of respose to a foreign agent that has been introduced in our body. In your case there are two things that I can derive from the history 1. Severe acidity- tramadol is a very strong painkiller and is know to cause severe acidity in some patients that are prone to it. it may be true in your case and if it is then some antacids along with PPI s should help in taking care of the same 2, as the nurse suspected, a SJS. this will need careful monitoring and management by a physician and an urgent consultation is the only way to do it. hope this helps and u feel better soon.