Last night I had a guy who I think had something I have only diagnosed once before. I believe he has Stevens-Johnson Syndrome, a very serious but luckily rare condition. Basically it is a poorly understood immune reaction – usually to certain drugs, most notably sulfa-containing drugs like the antibiotic, Bactrim (trimethoprim-sulfamethoxazole). The skin develops lesions which can blister and slough off – the typical presentation can vary but usually these lesions occur in the mouth, with the body having a less-serious appearing rash. This however can progress to something like you see in the above pictures. The guy last night was somewhat atypical in his appearance. He was 47 and was on and off Bactrim for a UTI for the last two weeks until a rash developed 4 days ago. His doctor stopped the drug and thought it was a typical allergic reaction, so he gave him an antihistamine. Unfortunately I don’t think it was….. he did not have the oral lesions but his penis took the brunt of it! The glans was terribly inflamed and there were ulcerations and weeping areas all down the shaft. The skin rash was milder and not ulcerating (yet). He had a fever and was tachycardic and just looked sick. I think he was in the early stages of the condition and came in mostly because he was supposed to leave for a trip to Vegas today! I told him that would be a bad idea and luckily he agreed to stay and get fluids and antibiotics. The treatment for SJS is basically like that for a burn – saline compresses and debridement of necrotic tissue as well and antibiotic prophylaxis. The only way to definitely diagnose SJS is by biopsy – so hopefully the inpatient team will arrange for that. Interesting, the residents (who usually groan when I give them admission at 1am) were truly excited for this case!
I had a friend who nearly died from SJS due to misdiagnosis and continuation of the ABX in ICU while the team tried to figure out what he had.
Nice work on the early diagnosis.
I work in a burn ICU where we treat all the SJS and TENS patients in the metropolitan area. It’s so refreshing to see that someone caught this diagnosis early, as we usually get the patients once they have taken a turn for the worst.
Could it be Fourniere gnagrene 2′ to UTI?
Either way, OUCH!
I thought of that SC but the rash on the rest of the body was more c/w SJS.
Does anyone remember the story about the woman who lost 100% of her skin to this? Not only did she shed all her epidermis, but the lining of her intestine, bile ducts, ureters, etc.
Incredibly, she made a complete recovery with minimal scarring.
Damn! Now I’ll be a lot better at remembering to take my Lamictal. That’s nasty.
my mother is a survivor of Steven Johnson disease.. and now she is still experiencing itchiness in her body.. maybe bcoz we are not knowledgeable of what kind of drug should she really take… what for is aloe Vera does it helps to relieve itchy?
was wondering. i forgot to ask my doctor but i have sjs…should i worry about serious scarring? i got the rash but not that bad.. it look purple on my skin now and not pink.. no opened sores.. my mouth is fine..and my penis.. however looks like its worse.. the skin on the head is kinda peeling and is knda red. should i just be fine taking the prednison that my doctor gave me and stay hydrated? ir should i be doing osmething to reduce scaring? thanks!
I had a lady patient who aquired this from a dose of Vancomycin. We had to fly her to a burn unit. Very sad…