A look at this deadly mucocutaneous reaction and how to best manage these patients in the ED


https://media.blubrry.com/coreem/content.blubrry.com/coreem/SJS.mp3



Download


Leave a Comment





Tags: Critical Care, Dermatology





Show Notes

Rash with dysuria should raise concern for SJS with associated urethritis

Dysuria present in a majority of cases


SJS is a mucocutaneous reaction caused by Type IV hypersensitivity

Cytotoxic t-lymphocytes apoptose keratinocytes → blistering, bullae formation, and sloughing of the detached skin


Disease spectrum

SJS = <10% TBSA
TEN = >30% TBSA
SJS/ TEN Overlap = 10-30% TBSA


Incidence is estimated at around 9 per 1 million people in the US
Mortality is 10% for SJS and 30-50% for TEN

Mainly 2/2 sepsis and end organ dysfunction.


SJS can occur even without a precipitating medication

Infection can set it off especially in patients with risk factors including HIV, lupus, underlying malignancy, and genetic factors
SATAN for the most common drugs

Sulfa, Allopurinol, Tetracyclines, Anticonvulsants, and NSAIDS


Anti-epileptics include carbamazepine, lamictal, phenobarb, and phenytoin


Can have a curious course

Hypersensitivity reaction can develop while taking medication, or even one to four weeks after exposure
In pediatric population, mycoplasma pneumonia and herpes simplex have been identified as precipitating infections


Patients often have a prodrome 1-3 days prior to the skin lesions appearing

May complain of fever, myalgias, headaches, URI symptoms, and malaise


Rash may be the sole complaint