Mini Poster - Stevens Johnson Syndrome

7/29/2019 Mini Poster - Stevens Johnson Syndrome

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SANDY KARTIKA P C11108214

NURUL AINI C11108785


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Patients IdentityName : Mrs. S

Gender : Female

Age : 56 years old

Marital Status : Married

Address : Jl. Vet. Utara LR 41/39

Admission Date : 3 February 2012


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History TakingChief complaint : rupture of blisters on the back,

chest, arms, abdomen, and lipatan paha

Happen 1 week ago, starts with appear blisters

on the left armpit and ruptured later. Shortlythereafter, the patient develops widespreadbullae that are easily ruptured.

Post operation of mammae (7 days before)Medication History : Tamopen, Dexamethasone,

Pirolesicam,

Fever (+) 1 day before bulla presented


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Physical ExaminationAnemic (-), icterus (-), cyanoses (-)

Erosion covering


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Current Status General status

Composmentis

Severe Sickness

Adequate nutrition Moderate Hygiene

Vital sign

Blood pressure : 110/90mmHg

Pulse rate : 80x/min

Respiration rate : 24x/min

Temperature : 36C


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Dermato-venerology StatusLocation 1 : Regio Mammae dextra,

abdomen sinistra

Effloresensi : Bulla

Location 2 : Regio extremities superior et

inferior,truncusposteriorEffloresensi : Bulla, vesicle, excoriation,

erosion, epidermolysis

Location 3 : Regio Mammae sinistra,Effloresensi : Ulcus post op Ca mammae

Location 4 : Regio oralis

Effloresensi : Stomatitis, crust


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Laboratory Result

Ureum : 129 mg/dl

Creatinin : 1,7 mg/dl

GDS : 66 mg/dl SGOT : 67 U/l

SGPT : 172 U/l

Natrium : 129,50 mmol/l

Kalium : 4,33 mmol/l

Chloride : 102,30 mmol/l


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Recommended examination

Consult diet

Consult ENT Chest X-ray examination

Punch biopsy

Immunofluorescence microscopy


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ResumeA 56 years old woman came to the hospital with

complain rupture of blisters on the back, chest, arms,abdomen, and lipatan paha. Happen 1 week ago, starts

with appear blisters on the left armpit and ruptured

later. Shortly thereafter, the patient developswidespread bullae that are easily ruptured. Pasien

mengeluh susah menelan. Nyeri pada lesi (+), gatal

pada lesi (+).

Post operation of mammae (7 days before). MedicationHistory : Tamofen, Dexamethasone, Piroxicam. Fever

(+) 1 day before bulla presented. Family medical

history with the same complain (-).


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DiagnosisStevens-Johnson Syndrome


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Treatment

1. Dexamethasone inj. 1 amp/ 6 h./ iv

2. Gentamicin 1 amp/12 h./ iv

3. Afucid cr.

4. Compress NaCl 0.3%


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PICTURES (9-02-2012)

Fig. 1 Fig.2

Figure 1: Stomatitis and crust on the upper and lower lips

Figure 2: Ulcus post op Ca mammae at the upper chest ofthe patient.


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Fig.3 Fig.4

Figure 3 and 4: SJS with bulla, vesicle, excoriation, erosion, and

epidermolysis on the armpit and arms.


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Fig.5 Fig.6

Figure 5: Bulla on the whole abdomen of the patient

Figure 6: Erosion, bulla, and excoration on the thighintertrigo


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STEVENS JOHNSON SYNDROME

Acute life-threatening mucocutaneousreactions characterized byextensive necrosis

and detachment of the epidermis.


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Idiopathic - 25%

Drug allergy 50%

- Analgesic- Antipyretic

- Anticonvulsan

- Traditional drug

And the other are Infections


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TRIAS:

Skin abnormality : The initial skin lesions are

characterized by erythematous, dusky

red, purpuric macules, irregularly shaped,

which progressively coalesce.Mucous membrane involvement : The

oral cavity and the vermilion border of the

lips are almost invariably affected and feature

painful hemorrhagic erosions coated

by grayish white pseudomembranes andcrusts of the lips

Extra-Cutaneous Symptoms : associated with high fever, pain,

and weakness


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Pathogenesis


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DiagnosisAnamnesis & history taking

Physical examination

Laboratory examinationo Low serum albumin and increase in gammaglobulins;

electrolyte imbalance; acute-phase proteins increased.

o

Leukocytosis (+) means the causes is infectiono Eosinofilia (+) means the causes is allergy


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Treatment

Remove any potential offending and unnecessary

medications

Address nutrition, fluid and electrolyte balance

Oral corticosteroid

Local skin care with compression to weeping orcrusted sites, bland emollients and mid-potencytopical corticosteroids

For secondary infection with systemic antibiotics


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Prognosis If the management is fast and adequate, the prognosis

is better.

The mortality rate is 5-12%. The prognosis is notaffected by the type or dose of the responsible drug orthe presence of human immunodeficiency virusinfection but depending on the severity of the disease

and the prior general condition of the patient.

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Mini Poster - Stevens Johnson Syndrome