Stevens-Johnson syndrome history and symptoms: Difference between revisions
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{{CMG}}; {{AE}} {{AHS}} | {{CMG}}; {{AE}} {{AHS}} | ||
==Overview == | ==Overview == | ||
Patients with Stevens-Johnson Syndrome usually have a history of recent drug use within the last 2 months or some other inciting trigger like infection or vaccination. It starts with a Flu-like illness followed by skin eruptions that involves trunk and extremities mainly. Skin involvement in SJS is always <10 percent of body surface. Blisters, erosions, vesicles and bullae are seen along with confluent redness and sloughing of skin. Mucosal lesions can be seen in 2 or more surfaces and can | Patients with Stevens-Johnson Syndrome usually have a history of recent drug use within the last 2 months or some other inciting trigger like infection or vaccination. It starts with a Flu-like illness followed by skin eruptions that involves trunk and extremities mainly. Skin involvement in SJS is always <10 percent of body surface. Blisters, erosions, vesicles and [[bullae]] are seen along with confluent redness and sloughing of skin. Mucosal lesions can be seen in 2 or more surfaces and can involve eyes, oral mucosa, nasopharynx or genitals commonly<ref name="pmid211627212">{{cite journal| author=Harr T, French LE| title=Toxic epidermal necrolysis and Stevens-Johnson syndrome. | journal=Orphanet J Rare Dis | year= 2010 | volume= 5 | issue= | pages= 39 | pmid=21162721 | doi=10.1186/1750-1172-5-39 | pmc=3018455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21162721 }}</ref>. | ||
==History and Symptoms== | ==History and Symptoms== | ||
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Symptoms usually start within 2 Months of starting a drug or other inciting trigger. | Symptoms usually start within 2 Months of starting a drug or other inciting trigger. | ||
* '''Prodome of Flu like symptoms 1-3 days before skin eruptions'''. May include | * '''Prodome of Flu like symptoms 1-3 days before skin eruptions'''. May include | ||
** Fever | ** [[Fever]] | ||
** Sore throat | ** [[Sore throat]] | ||
** Chills | ** [[Chills]] | ||
** Headache | ** [[Headache]] | ||
** Malaise | ** [[Malaise]] | ||
** Cough | ** [[Cough]] | ||
** Arthralgias | ** [[Arthralgia|Arthralgias]] | ||
* '''Skin lesions''' | * '''Skin lesions''' | ||
** Involve less than 10 percent of body surface | ** Involve less than 10 percent of body surface | ||
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** Confluent redness with skin sloughing | ** Confluent redness with skin sloughing | ||
** Nikolsky Sign is Positive- which is the detachment of superficial epidermis on gentle pressure or rubbing of skin | ** Nikolsky Sign is Positive- which is the detachment of superficial epidermis on gentle pressure or rubbing of skin | ||
** Target lesions are not typically seen (as opposed to Erythema Multiforme) | ** [[Target lesions]] are not typically seen (as opposed to [[Erythema Multiforme]]) | ||
* '''Mucosal Lesions''' | * '''Mucosal Lesions''' | ||
** Can be seen before or after the skin eruptions | ** Can be seen before or after the skin eruptions | ||
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** Seen in 90 percent of cases of SJS/TEN<ref name="pmid15875523">{{cite journal| author=Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS| title=Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. | journal=Ann Allergy Asthma Immunol | year= 2005 | volume= 94 | issue= 4 | pages= 419-36; quiz 436-8, 456 | pmid=15875523 | doi=10.1016/S1081-1206(10)61112-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15875523 }}</ref> | ** Seen in 90 percent of cases of SJS/TEN<ref name="pmid15875523">{{cite journal| author=Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS| title=Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. | journal=Ann Allergy Asthma Immunol | year= 2005 | volume= 94 | issue= 4 | pages= 419-36; quiz 436-8, 456 | pmid=15875523 | doi=10.1016/S1081-1206(10)61112-X | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15875523 }}</ref> | ||
** Involved mucosal surfaces may include<ref name="pmid21162721">{{cite journal| author=Harr T, French LE| title=Toxic epidermal necrolysis and Stevens-Johnson syndrome. | journal=Orphanet J Rare Dis | year= 2010 | volume= 5 | issue= | pages= 39 | pmid=21162721 | doi=10.1186/1750-1172-5-39 | pmc=3018455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21162721 }}</ref> | ** Involved mucosal surfaces may include<ref name="pmid21162721">{{cite journal| author=Harr T, French LE| title=Toxic epidermal necrolysis and Stevens-Johnson syndrome. | journal=Orphanet J Rare Dis | year= 2010 | volume= 5 | issue= | pages= 39 | pmid=21162721 | doi=10.1186/1750-1172-5-39 | pmc=3018455 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21162721 }}</ref> | ||
*** Buccal mucosa: Painful erosions leading to Stomatitis and Mucositis | *** Buccal mucosa: Painful erosions leading to [[Stomatitis]] and [[Mucositis]] | ||
*** Ocular: Seen frequently and range from acute conjuctivitis, eyelid edema and erythema, crusting, ocular discharge, Corneal erosion to corneal ulceration<ref name="pmid19243825">{{cite journal| author=Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z et al.| title=Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. | journal=Ophthalmology | year= 2009 | volume= 116 | issue= 4 | pages= 685-90 | pmid=19243825 | doi=10.1016/j.ophtha.2008.12.048 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19243825 }}</ref> | *** Ocular: Seen frequently and range from acute [[conjuctivitis]], eyelid edema and erythema, crusting, ocular discharge, Corneal erosion to corneal ulceration<ref name="pmid19243825">{{cite journal| author=Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z et al.| title=Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications. | journal=Ophthalmology | year= 2009 | volume= 116 | issue= 4 | pages= 685-90 | pmid=19243825 | doi=10.1016/j.ophtha.2008.12.048 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19243825 }}</ref> | ||
*** Urogenital : Can cause Urethritis, Vulvovaginitis | *** Urogenital : Can cause [[Urethritis]], [[Vulvovaginitis]] | ||
*** Nasopharynx | *** Nasopharynx | ||
*** Tracheo-Bronchial and intestinal involvement is uncommon<ref name="pmid9470079">{{cite journal| author=Lebargy F, Wolkenstein P, Gisselbrecht M, Lange F, Fleury-Feith J, Delclaux C et al.| title=Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study. | journal=Intensive Care Med | year= 1997 | volume= 23 | issue= 12 | pages= 1237-44 | pmid=9470079 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9470079 }}</ref> | *** Tracheo-Bronchial and intestinal involvement is uncommon<ref name="pmid9470079">{{cite journal| author=Lebargy F, Wolkenstein P, Gisselbrecht M, Lange F, Fleury-Feith J, Delclaux C et al.| title=Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study. | journal=Intensive Care Med | year= 1997 | volume= 23 | issue= 12 | pages= 1237-44 | pmid=9470079 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9470079 }}</ref> | ||
Revision as of 19:38, 12 September 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]
Overview
Patients with Stevens-Johnson Syndrome usually have a history of recent drug use within the last 2 months or some other inciting trigger like infection or vaccination. It starts with a Flu-like illness followed by skin eruptions that involves trunk and extremities mainly. Skin involvement in SJS is always <10 percent of body surface. Blisters, erosions, vesicles and bullae are seen along with confluent redness and sloughing of skin. Mucosal lesions can be seen in 2 or more surfaces and can involve eyes, oral mucosa, nasopharynx or genitals commonly[1].
History and Symptoms
History
Patients with SJS may have a positive history of:
- Recent Drug use
- Recent viral or bacterial infection
- Active malignancy
Symptoms
Symptoms usually start within 2 Months of starting a drug or other inciting trigger.
- Prodome of Flu like symptoms 1-3 days before skin eruptions. May include
- Skin lesions
- Involve less than 10 percent of body surface
- Start as red or reddish blue macules/papules on trunk and extremities and later increase in size and coalesce
- Blisters/Erosions/Bullae and Vesicles are seen
- Confluent redness with skin sloughing
- Nikolsky Sign is Positive- which is the detachment of superficial epidermis on gentle pressure or rubbing of skin
- Target lesions are not typically seen (as opposed to Erythema Multiforme)
- Mucosal Lesions
- Can be seen before or after the skin eruptions
- Can involve 2 or more mucosal surfaces
- Seen in 90 percent of cases of SJS/TEN[2]
- Involved mucosal surfaces may include[3]
- Buccal mucosa: Painful erosions leading to Stomatitis and Mucositis
- Ocular: Seen frequently and range from acute conjuctivitis, eyelid edema and erythema, crusting, ocular discharge, Corneal erosion to corneal ulceration[4]
- Urogenital : Can cause Urethritis, Vulvovaginitis
- Nasopharynx
- Tracheo-Bronchial and intestinal involvement is uncommon[5]
References
- ↑ Harr T, French LE (2010). "Toxic epidermal necrolysis and Stevens-Johnson syndrome". Orphanet J Rare Dis. 5: 39. doi:10.1186/1750-1172-5-39. PMC 3018455. PMID 21162721.
- ↑ Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS (2005). "Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature". Ann Allergy Asthma Immunol. 94 (4): 419–36, quiz 436-8, 456. doi:10.1016/S1081-1206(10)61112-X. PMID 15875523.
- ↑ Harr T, French LE (2010). "Toxic epidermal necrolysis and Stevens-Johnson syndrome". Orphanet J Rare Dis. 5: 39. doi:10.1186/1750-1172-5-39. PMC 3018455. PMID 21162721.
- ↑ Sotozono C, Ueta M, Koizumi N, Inatomi T, Shirakata Y, Ikezawa Z; et al. (2009). "Diagnosis and treatment of Stevens-Johnson syndrome and toxic epidermal necrolysis with ocular complications". Ophthalmology. 116 (4): 685–90. doi:10.1016/j.ophtha.2008.12.048. PMID 19243825.
- ↑ Lebargy F, Wolkenstein P, Gisselbrecht M, Lange F, Fleury-Feith J, Delclaux C; et al. (1997). "Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study". Intensive Care Med. 23 (12): 1237–44. PMID 9470079.