THE IMPORTANT ROLE OF ORAL MEDICINE SPECIALIST  IN MANAGEMENT OF STEVENS-JOHNSON SYNDROME PATIENT

ABSTRACTIntroduction: Stevens-Johnson Syndrome (SJS) is an acute hypersensitivity reaction that manifests on the skin, oral mucosa, ocular, gastrointestinal, genital and anal area. It is also potentially life-threatening in concern of dehydration and infection. Oral mucosal lesions due to SJS resulted in a significant decrease of patient’s quality of life. When the oral mucosa involved, the intake of nutrients and fluids is disrupted contributing to electrolyte imbalance that aggravates dehydration. Moreover, oral mucosal lesions have become an entry point for infection. Purpose: This case report describes the important role of oral medicine specialists in the management of oral mucosal lesions in SJS patient. Review: A 26-year-old female patient was referred from the Department of Dermatology and Venereology with a diagnosis of SJS et causa suspected paracetamol and/or amoxycillin. The complaints comprised of pain on the lips and oral cavity, difficulty in mouth opening, and pain when swallowing. The management for oral lesions included: history taking, external and intra oral examinations, dexamethasone mouthwash, nystatin oral suspension, and sodium chloride (NaCl) 0.9% solution. The patient showed improvement in oral mucosal lesions within 3 weeks of treatment that was provided by oral medicine specialist and medical team collaboration. Conclusion: Based on this case report, the role of oral medicine specialist is very important as part of the management team for SJS patient. Oral medicine specialist can reduce morbidity that results from oral mucosal involvement. Collaboration with oral medicine specialist since the beginning of treatment is the key to success in SJS management. Keywords: Oral medicine specialist, Oral mucosal lesion, Stevens-Johnson Syndrome.

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The Importance of Accurate Anamnesis in Determining Suspected Drugs Causing of Oral Manifestation of Stevens Johnson Syndrome-Toxic Epidermal Necrolysis (Case Report)

UI Proceedings on Health and Medicine ◽

10.7454/uiphm.v1i0.20 ◽

2017 ◽

Vol 1 ◽

Author(s):

Selvia Selvia ◽

Indriasti I Wardhany

Keyword(s):

Case Report ◽

Toxic Epidermal Necrolysis ◽

Information Gain ◽

Drug Hypersensitivity ◽

Critical Role ◽

Stevens Johnson Syndrome ◽

Sufficient Information ◽

Oral Medicine ◽

Oral Manifestation ◽

Johnson Syndrome

Introduction: Stevens - Johnson Syndrome (SJS) and Toxic epidermal necrolysis (TEN) are drug hypersensitivity life-threatening disease that involve skin and mucous membrane. Oral manifestation occurs in almost all the patients of SJS-TEN.Case report: A 52-years-old SJS-TEN female patient was referred from department of dermatology and venereology of RSCM hospital, Jakarta to the department of oral medicine, because of the painful ulcers in the mouth and difficulty to eat. Severe loss of integrity lesions was found in lips and oral mucosa. The causing drugs cannot be identified earlier because of challenging condition during anamnesis. The leading clue of suspected causative drugs was conducted by oral medicine specialist with in depth anamnesis of thorough patients’ medical history. Allergic test after six-week period after the patient first visit shows positive result of carbamazepine and amitriptyline hypersensitivity.Discussion: The delayed in determining causing drugs in this case were because of several causes, especially lack of information gain during anamnesis. In the condition when the operator cannot obtain sufficient information due to patient condition, it was very important to have an excellent communication in the collaborating medical team and patient family as well as constantly obtaining new important information during the ongoing treatment. Since the appropriate and successful treatment was depending in determining an exact cause, the anamnesis plays a critical role in this case.Conclusion: Accurate anamnesis by operator was an important part regarding the successful management of patient with SJS-TEN since the disease has an enormous impact in patient’s quality of life.

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