Urogynecologic complications in Stevens-Johnson syndrome and toxic epidermal necrolysis: Presentation of a case and recommendations for management

SCORTEN: severity-of-illness score for toxic epidermal necrolysis SJS: Stevens-Johnson syndrome TEN: toxic epidermal necrolysis CASE REPORT A 28-year-old gravida 2, para 1 female presented at 10 weeks’ gestation to the burn unit with 30% body surface area of full-thickness erosions and flaccid bullae on the face, trunk, extremities, and mucosal surfaces including the eyes, mouth, and vagina (Fig 1, A and B). Her symptoms began 2 days prior with stinging and swelling of the eyes and lips that quickly progressed to generalized erythema and subsequent blister formation and desquamation. Associated symptoms included headache, malaise, and fever up to 39.48C. Skin biopsy found vacuolar alteration and necrotic keratinocytes along the dermal-epidermal junction and sparse lymphocytic infiltrate, confirming the suspected diagnosis of toxic epidermal necrolysis (TEN) (Fig 1, C ). Her medical history was significant for culturepositive group A b-hemolytic streptococcal pharyngitis that was treatedwith a 10-day course of penicillin V potassium (500 mg twice daily) approximately 1 month before to the onset of her rash. At the time of presentation, she was taking a multivitamin and fish oil. Her laboratory serology results were negative for herpes simplex virus, human immunodeficiency virus, and mycoplasma pneumonia. Although her symptoms were potentially attributed to penicillin, it is unusual for TEN to occur 4 weeks after discontinuation of a medication with a short half-life. Thus, an altered immunologic state owing to pregnancy was