Resident Report 1/13 – SJS/TEN

SJS/TEN Teaching Pearls:

  • SJS/TEN are severe mucocutaneous lesions
    • <10% of epidermal involvement categorized as SJS.
    • >30% of epidermal involvement categorized as TEN
    • 10-30% of epidermal involvement categorized as SJS/TEN
  • Most commonly caused by:
    • Medications (allopurinol, anticonvulsants, sulfonamides, NSAIDS)
    • Infectious (mycoplasma pneumonia, CMV)
  • Clinical Manifestations:
    • Prodrome of fever and flu-like symptoms 1-3 days
    • Development of mucocutaneous and skin lesions that start as erythematous macules.
    • Progress to vesicles and bullae formation within days prior to sloughing.
    • Mucocutaneous involvement occurs in >90% of patients (oral, ocular, urogenital).
  • Complications
    • Fluid balance and electrolyte abnormalities
    • Infections
      • Staph Aureus and Pseudomonas
      • Fungemia
      • No role for empiric antibiotics.
    • Pulmonary
      • ARDS
      • Pneumonia
  • Management
    • High level of suspicion as early withdrawal of medications important for treatment.
    • Symptomatic care
      • Consult ophtho, burn, and derm
      • Patient should be transferred to ICU burn care if moderate to high severity of disease.
Dinstiguishing Features DRESS SJS/TEN
Rash Morphology  

Erythroderma, swelling, maculopapular rash

 

 

 

Vesicle/bullae formation followed by sloughing
Localization  

 

Diffuse, usually involves the face.

 

 

Diffuse; often spares the palms/soles, and scalp
Timing  

 

Occurs 2-8 weeks after medication intake

 

 

Occurs 3-21 days after medication intake
Internal Organ Involvement  

 

Lymphadenopathy, renal (AIN), hepatitis

 

 

Due to result of complication from SJS/TEN
Systemic signs Fever, malaise, fatigue

 

 

 

 

Fever, malaise, odynophagia
Lab Findings  

Eosinophilia

 

 

 

Lymphopenia, rarely eosinophilia

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