Differential Diagnosis of Superficial Ulcerations of the Oral Mucosa

1979 ◽  
Vol 87 (6) ◽  
pp. 734-740 ◽  
Author(s):  
Richard A. Chole ◽  
George H. Domb
Keyword(s):  
Differential Diagnosis ◽  
Oral Mucosa ◽  
Verrucous Carcinoma ◽  
Pemphigus Vulgaris ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Mucous Membrane Pemphigoid ◽  
Diagnostic Challenge ◽  
Johnson Syndrome ◽  
Herpetic Gingivostomatitis

Superficial ulcerations of the oral mucosa often present a diagnostic challenge to the physician because of the similarity of one ulcer to another. A diagnosis is made by the analysis of multiple factors, including the lesion's location, size, grouping, onset, patient's age, involvement of other systems of the body, and course of the disease. The histopathology of the lesion may be specific, especially in certain potentially fatal diseases. This paper presents the means for the differential diagnosis of a variety of superficial ulcers of the oral mucosa: varicella, herpangina, recurrent aphthous stomatitis, Behcet's disease, Stevens-Johnson syndrome, traumatic ulcer, verrucous carcinoma, primary herpetic gingivostomatitis, recurrent herpetic stomatitis, pemphigus vulgaris, and benign mucous membrane pemphigoid.

scholarly journals Mycoplasma Pneumoniae with Atypical Stevens-Johnson Syndrome: A Diagnostic Challenge

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Ralph Yachoui ◽  
Sharon L. Kolasinski ◽  
David E. Feinstein
Keyword(s):  
Clinical Diagnosis ◽  
Skin Rash ◽  
Oral Mucosa ◽  
Mycoplasma Pneumoniae ◽  
Stevens Johnson Syndrome ◽  
Atypical Presentation ◽  
Diagnostic Challenge ◽  
Johnson Syndrome ◽  
Mycoplasma Pneumoniae Infection

The Stevens-Johnson syndrome (SJS) classically involves a targetoid skin rash and the association of the oral mucosa, genitals, and conjunctivae. Recently, there have been several documentations of an incomplete presentation of this syndrome, without the typical rash, usually associated with the mycoplasma pneumoniae infection. Our case illustrates that this important clinical diagnosis should not be missed due to its atypical presentation.

scholarly journals ORAL SECONDARY INFECTION IN STEVENS-JOHNSON SYNDROME PATIENT WITH ORAL INVOLVEMENT: A CASE REPORT

2021 ◽  
Vol 6 (1) ◽  
pp. 79
Author(s):  
Etis Duhita Rahayuningtyas ◽  
Indah Suasani Wahyuni ◽  
Irna Sufiawati
Keyword(s):  
Case Report ◽  
Secondary Infection ◽  
Severity Of Illness ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
High Dose ◽  
Oral Manifestation ◽  
Secondary Infections ◽  
Johnson Syndrome ◽  
Oral Involvement

ABSTRACTBackground: Stevens-Johnson syndrome (SSJ) is a hypersensitivity reaction that is often triggered by drugs but this case is rare. These reactions result in uncontrolled keratinocyte damage to the skin and mucosa throughout the body, including the oral mucosa, and are often life-threatening. The use of high doses of corticosteroids is a treatment that is often given but it can trigger secondary infections of fungal and viral in the oral cavity. Purpose: This case report discusses the management of oral manifestations and secondary infections in SSJ patients, and becomes guidance for health professionals. Case: A-42-years-old male patient was consulted from the Department of Dermatology and Venereology (DV) due to oral pain and eating difficulties. The severity-of-illness-score for toxic-epidermal-necrolysis (SCORTEN) was 1. Erosive serosanguinous crusts, tend to bleed were found on the lips. Intraoral clinically presented wide erosive lesions and multiple ulcers, accompanied by a pseudomembranous plaque, and teeth decay. Hematologic examination showed an increase in leukocytes, neutrophil segments, monocytes, SGOT, urea, and creatinine as well as decreased hemoglobin, hematocrit, erythrocytes, MCHC, protein, and albumin. Anti-HSV1 IgG increased almost 6 times than normal values. The patient was diagnosed with SJS with oral involvement, secondary infections of pseudomembranous candidiasis, and herpetic stomatitis. Case Management: Systemic therapy given were intravenous dexamethasone, ranitidine, calcium, and cetirizine, from the DV Department, while hydrocortisone lip ointment, Chlorhexidine digluconate 0.12%, and Nystatin oral suspension for oral problems. The lesions progressed in 24 days. Conclusion: Oral secondary infections may occur in SJS patients due to high-dose corticosteroid therapy.Keywords: Herpetic Stomatitis, Oral Manifestation, Oral Secondary Infection, Pseudomembranous Candidiasis, Stevens-Johnson Syndrome.

scholarly journals Amoxicillin Induced Steven Johnson’s Syndrome: A Case Report

2020 ◽  
Vol 10 (4-s) ◽  
pp. 220-222
Author(s):  
R Mahendra Kumar ◽  
Sanatkumar Nyamagoud ◽  
Krishna Deshpande ◽  
Ankitha Kotian
Keyword(s):  
Adverse Drug Reaction ◽  
Drug Reaction ◽  
Case Reports ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Hypersensitivity Reactions ◽  
Johnson Syndrome ◽  
Oral Consumption ◽  
Life Threatening

Stevens-Johnson syndrome (SJS) is a very rare, potentially fatal skin reaction that is typically the result of reaction to the drug. In particular, SJS is characterized by extensive skin and mucous membrane lesions (i.e. mouth, nose, esophagus, anus, and genitalia), epidermis detachment, and acute skin blisters. In 95 % of case reports, drugs were found to be an important cause for the development of SJS. This story is a case of A 42 year old male hospitalized with rashes all over the body and fever, after oral consumption of Amoxicillin drug for sore throat. This case study discusses the possibility that serious hypersensitivity reactions with Amoxicillin can rarely occur and can be extremely harmful and life-threatening Menacing. Keywords: Toxic Epidermal Necrolysis, Stevens Johnson Syndrome, Adverse drug reaction, Nikolsky’s sign

Cephalexin-Induced Stevens-Johnson Syndrome

1992 ◽  
Vol 26 (10) ◽  
pp. 1230-1233 ◽  
Author(s):  
Kim M. Murray ◽  
Michael S. Camp
Keyword(s):  
Gastrointestinal Tract ◽  
Lupus Erythematosus ◽  
Skin Surface ◽  
Skin Lesions ◽  
Infectious Complications ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Medline Search ◽  
Johnson Syndrome ◽  
Macular Rash

OBJECTIVE: To report a case of cephalexin-induced Stevens-Johnson syndrome (SJS), a devastating adverse drug reaction that involves the entire skin surface and mucosal areas of the body. DATA SOURCES: MEDLINE search (key terms cephalosporins, Stevens-Johnson syndrome, erythema multiforme, and systemic lupus erythematosus) and references identified from bibliographies of pertinent articles. DATA SYNTHESIS: Clinical presentation and manifestations of SJS include the skin, eyes, gastrointestinal tract, and pulmonary system. Infectious complications are the leading cause of mortality. Early intervention is important to prevent progression of SJS. The case described is consistent with the features of this syndrome. The patient presented with fever, arthralgias, and malaise. Skin lesions included a diffuse violet macular rash with erythema and multiple bullous lesions on her neck and abdomen. The skin biopsy was consistent with SJS. Multiple mucocutaneous ulcers were found in her mouth, but no evidence of lower gastrointestinal tract involvement was documented. She remained relatively free of pulmonary complaints except for the presenting bronchitis. CONCLUSIONS: Cephalexin should be added to the list of agents to consider as iatrogenic causes of SJS.

scholarly journals Multidisciplinary care in Stevens-Johnson syndrome

2020 ◽  
Vol 11 ◽  
pp. 204062231989446 ◽  
Author(s):  
Swapna S. Shanbhag ◽  
James Chodosh ◽  
Cherie Fathy ◽  
Jeremy Goverman ◽  
Caroline Mitchell ◽  
...  
Keyword(s):  
Supportive Care ◽  
Toxic Epidermal Necrolysis ◽  
Oral Mucosa ◽  
Acute Phase ◽  
Multidisciplinary Care ◽  
Stevens Johnson Syndrome ◽  
Chronic Complications ◽  
Optimal Care ◽  
Johnson Syndrome ◽  
Organ Systems

Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.

scholarly journals Serum Granulysin in Differentiation of Stevens-Johnson Syndrome/toxic Epidermal Necrolysis and Erythema Multiforme

2020 ◽  
Vol 8 (B) ◽  
pp. 381-388
Author(s):  
Tran Thi Huyen ◽  
Pham Dinh Hoa ◽  
Trinh Minh Trang ◽  
Riichiro Abe ◽  
Nguyen Van Thuong ◽  
...  
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Body Surface ◽  
Erythema Multiforme ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Enzyme Linked Immunosorbent Assay ◽  
Drug Reactions ◽  
Skin Manifestation ◽  
Johnson Syndrome ◽  
Life Threatening

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening drug reactions, which lead to massive epidermal necrolysis. Granulysin plays an important role as a key mediator for keratinocyte apoptosis in these conditions. Erythema multiforme (EM) may have skin manifestation similar to SJS/TEN. AIMS: The aim of the study was to compare serum granulysin levels in patients with SJS/TEN and EM as well as to investigate a possible association between serum granulysin levels and the severity of SJS/TEN. METHODS: In total, 48 patients with SJS/TEN, 43 patients with EM, and 20 health controls (HCs) were enrolled. We measured serum granulysin levels using enzyme-linked immunosorbent assay. RESULTS: The average level of serum granulysin in the SJS/TEN patients was 23.0 ng/ml (range 1.2–144.6 ng/ml), significantly higher than that of EM group (20.1 ng/ml; range 8.5–121 ng/ml, p < 0.05) and HCs group (20.8 ng/ml; range 10.1–46.7 ng/ml, p < 0.05). Of 48 SJS/TEN patients, the 25 samples collected <6 days after onset showed higher level of serum granulysin (27.7 ng/ml; range 2.5–144.6 ng/ml) than those collected ≥6 days after onset (17.9 ng/ml; range 1.2–59 ng/ml; p > 0.05). No significant correlation was found between serum granulysin levels and the body surface area affected and the modified-SCORTEN. At the day of re-epithelialization, serum granulysin levels were not different compared with those at the day of hospitalization. CONCLUSIONS: Serum granulysin levels are significantly higher in SJS/TEN group than in EM group. After the onset, serum granulysin levels in patients with SJS/TEN are not a good biomarker to evaluate the severity of the diseases.

scholarly journals Phenytoin induced toxic epidermal necrolysis: a case report

2019 ◽  
Vol 8 (6) ◽  
pp. 1448
Author(s):  
Sandipan Barkakaty ◽  
Girish K.
Keyword(s):  
Oral Cavity ◽  
Toxic Epidermal Necrolysis ◽  
Past History ◽  
Clinical History ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Medicine Department ◽  
Johnson Syndrome ◽  
History Of ◽  
Emergency Medicine Department

Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), are severe idiosyncratic reactions characterized by fever and mucocutaneous lesions leading to necrosis and sloughing of the epidermis. The usage of anticonvulsants like carbamazepine, phenytoin, lamotrigine, phenobarbital are associated with high risk for occurrence of TEN. We present a case of toxic epidermal necrolysis in a 30 year old female probably induced by phenytoin. A 30 year old female was admitted to the emergency medicine department of KIMS hospital, Bengaluru. Lesions over the lips and oral cavity, multiple fluid filled blisters were present diffusely all over the body. Patient had a past history of oral cavity lesions with injection phenytoin. Patient is a known epileptic of over 12 years and was on treatment. Patient had a seizure attack 3 days back and visited nearby hospital and did not inform the doctor of her allergy to phenytoin. Patient was given inj phenytoin after which she developed oral lesions and also presented with fluid filled bullae all over the body. A diagnosis of toxic epidermal necrolysis was made based on clinical history and Scoreten score and was treated with betadine wash, fluconazole and antibiotics .The lesions improved significantly with the above management and patient recovered enough to be discharged from the hospital after 5 days. Severe and serious reactions such as toxic epidermal necrolysis can be caused by commonly used drugs like phenytoin.

scholarly journals MANIFESTASI ORAL DAN PENATALAKSANAAN PADA PENDERITA SINDROM STEVENS-JOHNSON

2011 ◽  
Vol 35 (2) ◽  
pp. 91
Author(s):  
Sri Ramayanti
Keyword(s):  
Supportive Care ◽  
Signs And Symptoms ◽  
Target Lesion ◽  
The Body ◽  
Stevens Johnson Syndrome ◽  
Oral Manifestation ◽  
Johnson Syndrome ◽  
Syndrome Diagnosis ◽  
Oral Abnormalities ◽  
Systemic Form

AbstrakSindrom Stevens-Johnson adalah bentuk penyakit mukokutan dengan tanda dan gejala sistemik yang parah berupa lesi target dengan bentuk yang tidak teratur, disertai macula, vesikel, bula, dan purpura yang tersebar luas terutama pada rangka tubuh. Sindrom Stevens-Johnson mempunyai tiga gelaja yang khas yaitu kelainan pada mata berupa konjungtivitis, kelainan pada genital berupa balanitis dan vulvovaginitis, serta kelainan oral berupa stomatitis. Diagnosis sindrom Stevens-Johnson terutama berdasarkan atas anamnesis, pemeriksaan klinis dan pemeriksaan penunjang perawatan pada penderita sindrom Stevens-Johnson lebih ditekankan pada perawatan simtomatik dan suportif karena etiologinya belum diketahui secara pasti.Kata Kunci : Sindrom Stevens-Johnson, manifestasi oral, manajemen perawatanAbstractStevens-Johnson Syndrome is a mucocutaneous disease with severe signs and symptoms of systemic form of the target lesion with an irregular shape, with the macula, vesicles, bullae, and widespread purpura, especially in the framework of the body. Stevens-Johnson syndrome have a typical three gelaja disorders of the eye such as conjunctivitis, genital abnormalities in the form of balanitis and vulvovaginitis, as well as oral abnormalities such as stomatitis. Stevens-Johnson syndrome diagnosis is mainly based on history, clinical examination and investigations treatment in patients with Stevens-Johnson syndrome were focused on symptomatic and supportive care because its etiology is not known with certainty.Key word : Stevens-Johnson syndrome, oral manifestation, treatment managementTINJAUAN PUSTAKA

scholarly journals Mycoplasma pneumoniae-Induced-Stevens Johnson Syndrome: Rare Occurrence in an Adult Patient

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Samad Rasul ◽  
Faria Farhat ◽  
Yared Endailalu ◽  
Fatima Tabassum Khan ◽  
Vishal Poddar
Keyword(s):  
Young Adults ◽  
Differential Diagnosis ◽  
Adult Patient ◽  
Mycoplasma Pneumoniae ◽  
Stevens Johnson Syndrome ◽  
Rare Occurrence ◽  
Drug Induced ◽  
Johnson Syndrome ◽  
Cutaneous Rash ◽  
Children And Young Adults

Stevens-Johnson syndrome (SJS) is an uncommon occurrence inMycoplasma pneumoniae(M. pneumoniae) infection (1–5%) and has been mainly reported in children and young adults. We present a case of SJS in a 32-year-old male induced byM. pneumoniaeinfection. This patient presented with fever, cough, and massive occupation of mucus membranes with swelling, erythema, and necrosis accompanied by a generalized cutaneous rash. He clinically responded after treatment with antibiotics and IVIG. SJS is usually a drug-induced condition; however,M. pneumoniaeis the commonest infectious cause and should be considered in the differential diagnosis.

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