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

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.

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MANIFESTASI ORAL DAN PENATALAKSANAAN PADA PENDERITA SINDROM STEVENS-JOHNSON

Majalah Kedokteran Andalas ◽

10.22338/mka.v35.i2.p91-97.2011 ◽

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

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Oral Manifestation of Stevens-Johnson Syndrome: a Case Report

Oral Surgery Oral Medicine Oral Pathology and Oral Radiology ◽

10.1016/j.oooo.2018.02.549 ◽

2018 ◽

Vol 126 (3) ◽

pp. e140-e141

Author(s):

Stéfanie Thieme Perotto ◽

Marina Girardi Schueigart ◽

Julia Turra Ribeiro ◽

Carolina Dummel ◽

Jéssica Rodriguez Strey ◽

...

Keyword(s):

Case Report ◽

Stevens Johnson Syndrome ◽

Oral Manifestation ◽

Johnson Syndrome

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Phenytoin Induced Stevens Johnson Syndrome- Toxic Epidermal Necrolysis Overlap Exacerbated by Cephalexin in a 65-Year-Old Neurosurgical Patient: A Rare Case Report

Current Drug Research Reviews ◽

10.2174/2589977513666210322160009 ◽

2021 ◽

Vol 13 ◽

Author(s):

Kiran Kumar Rathinam ◽

Sarvesh Sabarathinam ◽

Poojith Nuthalapati ◽

Vijayakumar Thangavel Mahalingam

Keyword(s):

Case Report ◽

Rare Case ◽

Detailed Examination ◽

The Body ◽

Stevens Johnson Syndrome ◽

Communicating Hydrocephalus ◽

Drug Induced ◽

Johnson Syndrome ◽

Rare Case Report ◽

Epidermal Necrosis

Objective: To report a rare case of drug induced overlap of Stevens-Johnson syndrome and Toxic Epidermal Necrosis Syndrome exacerbated by cephalexin. Case summary: In this case report we present a 65-year-old female who had come to the hospital with complaints of Sloughing of the skin and redness all over the body with raised body temperature. She was on therapeutic Phenytoin to prevent the post-surgical complications of Communicating Hydrocephalus. After a detailed examination it was found that the patient had misemployed with an overdose of Phenytoin. The patient was found with nikolsky sign and diagnosed as Stevens-Johnson syndrome and Toxic Epidermal Necrosis overlap. This case report emphasizes phenytoin induced Stevens-Johnson syndrome and Toxic Epidermal Necrosis syndrome exacerbated by cephalexin. Practice implications: By witnessing this phenomenon, we could figure out the association between cephalexin and Stevens-Johnson syndrome- Toxic Epidermal Necrosis syndrome overlap. The Immediate dismissal of the offending agent and commencement of supportive care was found to be effective.

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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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A CASE REPORT ON AMOXICILLIN INDUCED STEVENS- JOHNSON SYNDROME

International Research Journal of Pharmacy ◽

10.7897/2230-8407.1207152 ◽

2021 ◽

Vol 12 (7) ◽

pp. 22-24

Author(s):

Rispa Darabadi ◽

Karasani Harini

Keyword(s):

Case Report ◽

Mucous Membrane ◽

Case Reports ◽

The Body ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Oral Consumption ◽

Life Threatening ◽

Steven Johnson Syndrome

Steven-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membrane that is usually a reaction to medication. It usually starts with flu-like symptoms, followed by a painful rash that spreads and blisters. Other symptoms include Fever, sore mouth and throat, Fatigue, burning eyes, 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 identified to be an important cause for the development of SJS. The below is a case report of A 37-year-old male patient hospitalized with rashes over the body and fever, after oral consumption of Amoxicillin drug for cough and sore throat through OTC prescription. The patient has taken three doses of Amoxicillin and due to lack of awareness on Adverse drug reactions, the patient ignored the rashes that were developed after the first dose. This case study discusses the possibility of serious hypersensitivity reactions with Amoxicillin that rarely occur and can be extremely harmful and life threatening, brief knowledge on Stevens-Johnson syndrome and also some of the preventive measures to control the adverse reactions due to drugs.

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Sulfadiazine induced Stevens Johnson syndrome in toxoplasmosis patient: a case report

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20204108 ◽

2020 ◽

Vol 9 (10) ◽

pp. 1615

Author(s):

Sagar Raju ◽

Shilpa Shashidharan ◽

Rani M. Kurian ◽

Rima Ramla ◽

Arun Paingamkulangara

Keyword(s):

Case Report ◽

Health Care Professionals ◽

Adverse Reactions ◽

Case Reports ◽

Secondary Infection ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Indian Male ◽

Severe Skin Reaction ◽

Epidermal Necrosis

Stevens johnson syndrome is an acute, self-limited disease, presenting as severe mucosal erosions with widespread erythematous, cutaneous macules or atypical targets. Even though sulfadiazine has been mainly associated with haematological-related adverse effects, sulfadiazine induced skin necrosis has received less attention or went unrecognized. Here is a 29-year- old Indian male received T. Sulfadiazine 500mg 1-1-1-1 and experienced a severe skin reaction which was diagnosed as stevens johnson syndrome (SJS). The above drug will be implicated in cases of stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). There are few case reports of that have been associated with stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). We hope that this case report creates awareness to the health care professionals. Clinicians must be aware of these adverse reactions and advise their patients to contact them as soon as they observe any unexpected clinical response. Early diagnosis helps the clinician to elude secondary infection and subsequent complications. The offending drug should be discontinued and never be rechallenged.

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