The physician diagnosed Stevens-Johnson syndrome (SJS) secondary to a sulfa antibiotic in this patient. SJS presents as a generalized cutaneous lesion with blisters, fever, malaise, arthralgias, headache, sore throat, nausea, vomiting, and diarrhea. The patient may also have difficulty eating, drinking, or opening his or her mouth secondary to erosion of oral mucous membranes.
SJS presents with erythematous or pruritic macules, widespread blisters on the trunk and face, and erosions of one or more mucous membranes. Epidermal detachment occurs and involves less than 30% of total body surface area. Toxic epidermal necrolysis (TEN) is the most severe side of the SJS spectrum.
Drugs most commonly known to cause SJS and TEN are sulfonamide antibiotics, allopurinol, nonsteroidal anti-inflammatory drugs, amine antiepileptic drugs (phenytoin and carbamazepine), and lamotrigine. Fifty percent of SJS/TEN cases have no identifiable cause. Not all SJS is secondary to drug exposure, but it is the clinician’s responsibility to investigate this cause and stop any suspicious medications. In this case, the trimethoprim/sulfamethoxazole was stopped immediately and the patient was admitted to the hospital for intravenous fluids and supportive care.
Text for Photo Rounds Friday courtesy of Richard P. Usatine, MD. Photo courtesy of Eric Kraus, MD. This case was adapted from: Allred A, Usatine R. Cutaneous drug reactions. In: Usatine R, Smith M, Mayeaux EJ, et al, eds. The Color Atlas of Family Medicine. New York, NY: McGraw-Hill; 2009:869-877.
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