Stevens-Johnson Syndrome, Mucositis, or Something Else?

[摘要] Stevens-Johnson syndrome (SJS) has been described in the literature as a combination of erythematous blistering skin lesions covering <10% of body surface area and ≥1 mucous membrane erosion.1 SJS is usually triggered by a medication or infection. Infectious causes are more common in children, most notably herpes simplex virus (HSV) and Mycoplasma pneumoniae. Mucous membrane erosions without significant skin involvement have been classified as “atypical SJS” and mucositis.2Case: An 18-year-old high school senior presented to his physician with a 2-week history of sore throat and cough, 1-week history of fever, and 1-day history of swollen lips and mucosal ulcerations in his mouth accompanied by pain with swallowing. He was an otherwise healthy adolescent male, with the exception of a PICU admission for anaphylaxis without obvious trigger 8 years ago and attention-deficit/hyperactivity disorder for which he is taking methylphenidate. The treating physician ordered a chest radiograph that demonstrated streaky infiltrates in the right lower lobe and sent serology samples for Mycoplasma , immunoglobulin G (IgG) antibodies for HSV type 1 and 2, and HIV testing. The patient was started empirically on azithromycin and acyclovir, with lidocaine viscous for his mouth sores. The following day he developed conjunctival erythema, urethral ulceration, and continued to have poor oral intake; he was therefore admitted to the inpatient pediatric ward for intravenous hydration, pain control, and further observation.Question: Does this patient have SJS? Discussion: There is disagreement in the literature on the exact definition of SJS. As first described by Stevens and Johnson in 1922, a patient must have a generalized skin eruption in conjunction with mucosal involvement to meet the definition.3 This patient never had a generalized skin eruption and therefore does not meet the classic criteria. He did, however, develop 1 targetoid lesion with a central blister on …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob