scholarly journals Is It Stevens–Johnson Syndrome or MIS-C with Mucocutaneous Involvement?

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Abdollah Karimi ◽  
Elham Pourbakhtiaran ◽  
Mazdak Fallahi ◽  
Fereshteh karbasian ◽  
Shahnaz Armin ◽  
...  
Keyword(s):  
Stevens Johnson Syndrome ◽  
Positive Polymerase Chain Reaction ◽  
Case Presentation ◽  
Reactive Protein ◽  
Johnson Syndrome ◽  
Initial Care ◽  
Mucosal Involvement ◽  
Polymerase Chain ◽  
Maculopapular Rashes ◽  
Inflammatory Syndrome

Background. Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) can be present in the form of multisystem inflammatory disease in children. Case Presentation. A 25-month-old boy presented with fever, malaise, diffuse maculopapular rashes, and mucosal involvement during the COVID-19 pandemic. He was first diagnosed with Stevens–Johnson syndrome (SJS). Further evaluation revealed lymphopenia, thrombocytopenia, and elevated levels of C-reactive protein (CRP), ferritin, and fibrinogen. This was followed by a positive polymerase chain reaction (PCR) test for COVID-19. In addition to receiving initial care for SJS, he was treated for MIS-C, which led to his recovery after four days. Conclusion. COVID-19 infection should be considered in children with fever and dermatological features during the pandemic because it may cause different features of the multisystem inflammatory syndrome in children (MIS-C), suggestive of delayed hyperimmune response.

scholarly journals MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN: DIAGNOSTIC MARKERS AND FEATURES OF PHARMACOTHERAPY

2021 ◽  
Vol 17 (1) ◽  
pp. 24-28
Author(s):  
M.V. Кhaitovych ◽  
L.M. Voroniuk ◽  
G.Yu. Borisova ◽  
N.V. Diudenko ◽  
N.M. Miagka
Keyword(s):  
Distress Syndrome ◽  
The United States ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Markers Of Inflammation ◽  
Laboratory Markers ◽  
Mucous Membranes ◽  
Coronavirus Infection ◽  
Polymerase Chain ◽  
Inflammatory Syndrome

Relevance. In 2020, children were hospitalized with fever and multisystem inflammation throughout the world during the COVID-19 pandemic. In the United States, this condition is called MIS-C (Multisystem Inflammatory Syndrome in Children). This syndrome is thought to be similar to the severe course of COVID-19 in adults (cytokine storm). The objective of the work is to evaluate the features of the course and pharmacotherapy of multisystem inflammatory syndrome in children. Materials and methods. The study included 17 children (10 boys and 7 girls) aged 3-16 years (on average – 9.5±3.4 years). Diagnosis of coronavirus infection was performed by polymerase chain reaction with real-time detection, determined the level of immunoglobulins M and G before coronavirus infection. Results. The duration of fever in patients was 5-21 days (average 8.1±4.0 days), the duration of inpatient treatment – 7-35 days (average 15.7±7.0 days). Blood albumin levels were reduced in 53.8% of children; the level of fibrinogen was increased in 88.2% of children, the level of C-reactive protein, ferritin, and D-dimer – in all patients. 15 (88.2%) children had pathology of the digestive system, 13 (76.5%) – cardiovascular system (7 children were diagnosed with carditis, 2 – dilation of coronary arteries, 7 – cardiac arrhythmia). Acute respiratory distress -syndrome was found in a 13-year-old girl, shock - in an 11-year-old boy, 11 children (64.7%) were diagnosed with the pathology of the respiratory system (pleurisy, pneumonia), skin and mucous membranes, and 4 children (23.5%) there were manifestations of central nervous system disorders (meningism, decreased reflexes, ataxia), in 2 (11.8%) – renal failure. On average, each patient had lesions of 3.9 ±1.2 systems. Conclusions. MIS-C was manifested by prolonged fever, high levels of laboratory markers of inflammation, hypoalbuminemia, hypercoagulation, often – pathological manifestations of the cardiovascular, digestive, respiratory systems, skin, and mucous membranes. The treatment included intravenous immunoglobulin, steroids, anticoagulant, and antibacterial therapy and was effective.

Head and Neck Manifestations of Erythema Multiforme in Children

1994 ◽  
Vol 111 (3P1) ◽  
pp. 236-242 ◽  
Author(s):  
Michael G. Stewart ◽  
Newton O. Duncan ◽  
Daniel J. Franklin ◽  
Ellen M. Friedman ◽  
Marcelle Sulek
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Head And Neck ◽  
Erythema Multiforme ◽  
Medication Use ◽  
Stevens Johnson Syndrome ◽  
Striking Increase ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Mucous Membranes

Erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis are related disorders of skin and mucous membranes, which are typically associated with antecedent medication use or infection. We review 108 cases of erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis from Texas Children's Hospital, Houston, Texas, from 1981 to 1991, and illustrate the characteristic skin and mucosal lesions. In addition, we describe in detail two unusual cases requiring intensive airway management. Head and neck manifestations were present in 4 of 79 patients (5%) with erythema multiforme and 26 of 28 patients (93%) with Stevens-Johnson syndrome. In Stevens-Johnson syndrome, mucosal involvement of the lip (93%), conjunctiva (82%), oral cavity (79%), and nose (36%) were most common. Antecedent medication use was identified in 59% of erythema multiforme patients and 68% of Stevens-Johnson syndrome patients. We note a striking increase in the number of cases in our series caused by cephalosporins. Fifty percent of Stevens-Johnson syndrome patients required supplemental hydration or alimentation because of the severity of the oral cavity involvement. The head and neck mucosal manifestations largely respond to local care, and the routine use of prophylactic antibiotics or systemic steroids is not recommended.

scholarly journals A Case Report of Steven Johnson Syndrome

2021 ◽  
pp. 132-139
Author(s):  
Archana Dhengare ◽  
Ranjana Sharma ◽  
Sonali Waware ◽  
Pranali Wagh
Keyword(s):  
Stevens Johnson Syndrome ◽  
Skin Allograft ◽  
Case Presentation ◽  
Johnson Syndrome ◽  
Chief Complaints ◽  
Long Time ◽  
History Of ◽  
Long Term Consequences ◽  
Steven Johnson Syndrome

Introduction: In 1922, two doctors, Albert Mason Stevens and Frank Johnson, examined purulent conjunctivitis.” Background: Stevens-Johnson syndrome was named after them as a result of their study. The incidence rate is 7 cases per million populations per year. Case Presentation: Master Yash Ghudam was brought to AVBRH by his parents with chief complaints of fever since 5 days and erythematous lesions all over body since 3 days. History of present illness: Patient was apparently alright 5 days back, and then he started having fever which was of high grade and was not associated with chills and rigor. Patient was treated on OPD basis and the symptoms of an unexplained disease in two young boys, aged 7 and 8, who had "an unusual, generalised eruption of continued fever, inflamed buccal mucosa, and extreme some antibiotic was given, but there was no relief, after 2 days there was ulcers formation inside the mouth for which some ointment and syrup becosule was started. But lesions were increasing. 3 days back the lesions first appeared on chest then got spread to legs and hands. For which patient was admitted in Chandrapur hospital from were the patient was referred to AVBRH for further management. Interventions: The patient was treated the patient was started on intravenous and orally Cortecosteroids, Omnacortil 10mg, Antibiotics- Inj. Ceftriaxone1gm IV 12 hourly [100mg/kg/day], inj. Amikacin 150mg IV 12 hourly [15mg/kg/day], Syp. Mucaine gel 2tsp BD – swish and swallow), Syp. Cital  2.5ml TDS, Tab. Chymoral Forte  TDS, Inj. Pantop 20mg IV 24 hourly (1mg/kg/dose). Pandya’s Formula: Syp. Gelusil 5ml, Syp. Benadryl 5ml, Syp. Omnacortil 5ml.  Skin allograft: It has been planned. Conclusion: In this study, we mainly focus on medical management and outstanding nursing care helped prevent farther complication. Overall, the patient's reaction was positive, though recovery time from Steven johnson syndrome varies from person to person, taking weeks, months, or even years. However, only a small number of people completely recover, while some have long-term consequences. She took a long time to get back on her feet.

scholarly journals A clinical study of Stevens-Johnson syndrome and toxic epidermal necrolysis in a tertiary centre, South India

2017 ◽  
Vol 3 (1) ◽  
pp. 134
Author(s):  
Rahima S. ◽  
Abdul Latheef E. N. ◽  
Pavithran K. ◽  
Saleem P. M.
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
South India ◽  
Detailed Examination ◽  
Stevens Johnson Syndrome ◽  
Hiv Positive ◽  
Tertiary Centre ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Common Causes ◽  
Eye Involvement

<p class="abstract"><strong>Background:</strong> Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered as the severest end of spectrum of erythema multiforme. Various etiologies like infections, drugs and malignancies have been proposed. The aim of the present study was to know the incidence, common causes, clinical course of SJS and TEN and to estimate the morbidity and mortality<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> A 2 year study of patients presenting with SJS and TEN was carried out. A detailed examination to know the cutaneous and mucosal involvement was done. Biopsy was done in 3 patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> There were fifty patients of SJS-TEN spectrum. Of which 31 were SJS, 3 had SJS-TEN overlap and 16 had TEN.  Anticonvulsants were implicated in causing these reactions in 24 patients (48%) with carbamazepine being the most common i.e. in 16 patients (32%). Sparing of pressure areas like the strap area of brassier and waist was noticed in two patients (4%). The most common complication was due to eye involvement seen in 20 patients (40%). 46 patients were treated with steroids and of the remaining, 3 were children and one was HIV positive. Only three patients with TEN (6%) died<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> To conclude, TEN was less common than SJS, had more sequelae and more mortality compared to SJS<span lang="EN-IN">.</span></p><p class="abstract"> </p>

scholarly journals Systemic lupus erythematosus presenting as stevens johnson syndrome in a thirty years old female: a case report

2019 ◽  
Vol 6 (1) ◽  
pp. 20-21
Author(s):  
Mohammad Shariq Mukarram
Keyword(s):  
Case Report ◽  
Lupus Erythematosus ◽  
Stevens Johnson Syndrome ◽  
High Grade Fever ◽  
Rheumatology Clinic ◽  
Case Presentation ◽  
Oral Ulcers ◽  
Johnson Syndrome ◽  
Dermatological Condition ◽  
Autoimmune Condition

Background: SJS occurs almost exclusively secondary to drugs but very rarely, SLE can be an inciting factor for SJS without presence of an offending drug. The association is extremely rare, however few cases have been reported. Case presentation: We present a case report of a thirty year old female who presented to the rheumatology clinic with complaints of rash on her face, swelling of the lips and oral ulcers with severe hemorrhagic cheilitis. She also complained of persistent high grade fever with development of blisters on her face and oropharyngeal mucosa. She had been suffering from pain in multiple joints which did not respond to NSAIDs. A diagnosis of SLE presenting as SJS was established. Patient was given good supportive care, steroids, DMARDs and analgesics, to which she responded well and recovered. Conclusion: Stevens Johnson Syndrome is an uncommon, severe dermatological condition usually caused secondary to drugs. Secondary cause of the disease may rarely be co-existence of an autoimmune condition like SLE, as present in our patient.

scholarly journals Presentation of COVID-19 infection with bizarre behavior and encephalopathy: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Zahra Teimouri-Jervekani ◽  
Mehrzad Salmasi
Keyword(s):  
Health Care Providers ◽  
Underlying Disease ◽  
Cerebrovascular Diseases ◽  
Care Providers ◽  
Chain Reaction ◽  
Positive Polymerase Chain Reaction ◽  
Case Presentation ◽  
Polymerase Chain ◽  
Tomography Scan ◽  
Bizarre Behavior

Abstract Background Current studies show that patients with severe coronavirus disease 2019 (COVID-19) have neurological symptoms manifesting as acute cerebrovascular diseases, impaired consciousness, and skeletal muscle symptoms. Bizarre behavior is an unusual and unique presenting symptom of COVID-19 infection in our patient. Case presentation We report a case of COVID-19 infection in a middle aged Iranian man without underlying disease who presented with bizarre behavior. Results of brain imaging were normal, but COVID-19 pneumonia was detected on chest computed tomography scan. Given the respiratory problem and positive polymerase chain reaction (PCR) test for COVID-19, treatment with hydroxychloroquine was administered, and after 2 days all of the symptoms resolved. Conclusions Encephalopathy and encephalitis may be a possible presentation of COVID-19. Clinicians and health care providers should consider the presence of COVID-19 with bizarre behavior during this COVID-19 pandemic.

scholarly journals Experience with the use of siltuximab in patients with SARS-CoV-2 infection

2021 ◽  
Author(s):  
Fernanda Meira ◽  
Laia Albiach ◽  
Cristina Carbonell ◽  
José-Ángel Martín-Oterino ◽  
Mercedes Martín-Ordiales ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Nasopharyngeal Swab ◽  
C Reactive Protein ◽  
Median Dose ◽  
First Line ◽  
Chain Reaction ◽  
Positive Polymerase Chain Reaction ◽  
Reactive Protein ◽  
Polymerase Chain ◽  
Hospital Clinic

Objectives. The study aims to describe characteristics and clinical outcome of patients with SARS-CoV-2 infection that received siltuximab according to a protocol that aimed to early block the activity of IL-6 to avoid the progression of the inflammatory flare. Patients and methods. Retrospective review of the first 31 patients with SARS-CoV-2 treated with siltuximab, in Hospital Clinic of Barcelona or Hospital Universitario Salamanca, from March to April 2020 with positive polymerase-chain reaction (PCR) from a nasopharyngeal swab. Results. The cohort included 31 cases that received siltuximab with a median (IQR) age of 62 (56-71) and 71% were males. The most frequent comorbidity was hypertension (48%). The median dose of siltuximab was 800 mg ranging between 785 and 900 mg. 7 patients received siltuximab as a salvage therapy after one dose of tocilizumab. At the end of the study, a total of 26 (83.9) patients had been discharged alive and the mortality rate was 16.1% but only 1 out of 24 that received siltuximab as a first line option (4%). Conclusions. Siltuximab is a well-tolerated alternative to tocilizumab when administered as a first line option in patients with COVID-19 pneumonia within the first 10 days from symptoms onset and high C-reactive protein.

scholarly journals Recent Updates in the Treatment of Erythema Multiforme

Medicina ◽  
2021 ◽  
Vol 57 (9) ◽  
pp. 921
Author(s):  
Alexa Soares ◽  
Olayemi Sokumbi
Keyword(s):  
Erythema Multiforme ◽  
Viral Infections ◽  
Immunosuppressive Agents ◽  
Symptomatic Treatment ◽  
Stevens Johnson Syndrome ◽  
Topical Steroids ◽  
Johnson Syndrome ◽  
Mucosal Involvement ◽  
Simplex Virus ◽  
Antiviral Medications

Erythema multiforme (EM) is an immune-mediated condition that classically presents with discrete targetoid lesions and can involve both mucosal and cutaneous sites. While EM is typically preceded by viral infections, most notably herpes simplex virus (HSV), and certain medications, a large portion of cases are due to an unidentifiable cause. EM can be confused with other more serious conditions like Stevens–Johnson syndrome (SJS); however, clinical research has provided significant evidence to classify EM and SJS as separate disorders. Treatment of EM is highly variable, depending on the etiology, the involvement of mucosal sites, and the chronicity (acute vs. recurring) of the disease. If the etiology or causal medication/infection is identified, then the medication is stopped and/or the infection is treated prior to initiating symptomatic treatment. Treatment for acute EM is focused on relieving symptoms with topical steroids or antihistamines. Treatment for recurrent EM is most successful when tailored to individual patients. First line treatment for recurrent EM includes both systemic and topical therapies. Systemic therapies include corticosteroid therapy and antiviral prophylaxis. Topical therapies include high-potency corticosteroids, and antiseptic or anesthetic solutions for mucosal involvement. Second-line therapies for patients who do not respond to antiviral medications include immunosuppressive agents, antibiotics, anthelmintics, and antimalarials

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