A Case Report Sjs
A Case Report Sjs
Abstract
Physicians writing prescriptions for patients must be careful regarding
the adverse effects of the drugs especially the one is the StevensJohnson syndrome (SJS), a potentially fatal condition that manifests
not only as mucocutaneous disorder but also affects vital organs. We
report a case of Steven Johnson syndrome with mucocutaneous
manifestation due to amend of the drug. Care for patients with
Stevens-Johnson syndrome consists of treating the presenting
symptoms, electrolyte balance, sketch and confiscation of the drug
which manifest this condition in the patient.
Key words:
Stevens-Johnson syndrome; Erythema Multiforme;
Mucocutaneous disorder.
Introduction
The term Erythema Multiforme (EM) includes a wide range of
clinical expressions, from exclusive mucous or skin erosions to
mucocutaneous lesions (EM minor) and, in its more severe forms,
there is a serious involvement of multiple mucosal membranes and
skin (EM major, Stevens-Johnson Syndrome) or a large area of the total
body surface including mucous surfaces (Toxic Epidermal Necrolysis)
with constitutional symptoms and, at times, visceral involvement (1).
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 epidermal
necrolysis is the most severe (2).
Case report
An 18 year old male patient reported
to our department with the chief complaint
of burning sensation and soreness of mouth
since three days. Patient was apparently
normal a week ago after which he developed
burning sensation, stickiness of eyes and
scanty mucopurulent discharge three days
ago and two days later he developed soreness
of mouth, difficulty in swallowing and
burning sensation on consumption of food.
His medical history revealed epilepsy from
past 10 years for which he is on phenytoin
since 10 years. He had history of intermittent
fever for which he had been to a local doctor
7 days ago for which he was prescribed some
medication followed by which fever
subsided, in addition medication for epilepsy
was
changed
from
phenytoin
to
phenobarbitone. Patient gave history of
similar complaint two years ago.
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Discussion
Stevens-Johnson syndrome a form of
mucocutanous disorder occurs most often in
children and young adults. Incidence ranges
from 1.2 to 6 cases per million per year (4). In
70% of SJS cases, drugs are found to be
causative agents and more than 100 such
agents have been reported. In SJS, its
necessary to take drug history carefully and
repeatedly before the causative agent can be
identified (2). In our patient one week before
the occurrence of the lesions, his drug
regimen for epilepsy was changed from
phenytoin to phenobarbitone. So, we could
postulate that phenobarbitone was the
offending drug that had caused Steven
Johnson syndrome. Ruggiero et al., reported
SJS in two children with brain tumour while
receiving
cranial
irradiation
and
anticonvulsant therapy with phenobarbital
(5). Similarly, Adeloye et al., reported two
cases of Stevens-Johnson syndrome in
patients with penetrating head wounds who
were treated with phenobarbitone (6).
Stevens-Johnson syndrome can be
preceded by a prodrome consisting of fever,
malaise, sore throat, nausea, vomiting,
arthralgias, and myalgias. This prodrome is
followed within 14 days by conjunctivitis and
by bullae on the skin and on the mucosal
membranes of the mouth, nares, pharynx,
esophagus, urethra, and vulvovaginal as well
Conclusions
Stevens-Johnson syndrome is a
potentially fatal disorder with a strong
alliance to some medications. Physicians
must therefore be careful in prescribing the
drugs to their patients. Moreover, as this
condition involves multiple organs, it can be
best treated by early involvement of medical
specialists.
49
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