Stevens-Johnson Syndrome: A Case Study

Physicians writing prescriptions for their patients must warn them about possible side effects. One such potential complication of drugs—including tetracycline—is Stevens-Johnson syndrome, a potentially fatal condition that manifests mainly on the skin and mucosal surfaces but also affects other vital organs. Many types of therapy have proved efficacious for treating the syndrome, but use of steroid agents for this purpose remains controversial. Care for patients with Stevens-Johnson syndrome consists of treating the presenting symptoms. Introduction Stevens-Johnson syndrome, otherwise known as erythema multiforme majus, is thought to represent a continuum of disease, the most benign type of which is erythema multiforme, whereas toxic epidural necrolysis is the most severe. The condition was first described in 1922 by Stevens and Johnson as a febrile illness with stomatitis, purulent conjunctivitis, and skin lesions. The syndrome is generally described as vesiculobullous erythema multiforme of the skin, mouth, eyes, and genitals. Case Report A 14-year-old male patient presented to the emergency department complaining of four days of increasing dysphagia, dysuria, photophobia, and a macular rash extending from the trunk toward the extremities. The only medication used by the patient was tetracycline, which he had been taking for two weeks as treatment for facial acne. Vital signs were normal except for a temperature of 103.1°F. He appeared ill and had copious amounts of ocular drainage as well as small vesicles on the nasal and oral mucosa. An erythematous rash on his chest coalesced on the trunk with many small vesicles, some forming bullae. Vesicles were also present on the penis and scrotum. The white blood cell count was slightly elevated at 11.7 × 10/L. Blood, herpes, and mycoplasma cultures as well as results of both rapid plasma reagin test and anti-DNA test were negative; and results of a skin biopsy were consistent with Stevens-Johnson syndrome. The presumptive cause was tetracycline. Empirical therapy with acyclovir was started but was discontinued after results of herpes culture proved negative. A regimen of 60 mg prednisone given intravenously twice daily was also started. When the oral lesions became so painful that the patient could not swallow his own saliva, a regimen of total By Matthew Smelik, MD ... thought to represent a continuum of disease, the most benign type of which is erythema multiforme, whereas toxic epidural necrolysis is the most severe. Erythematous rash