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Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis comprise a spectrum of severe hypersensitivity skin reactions. Stevens-Johnson Syndrome is the least severe on the spectrum of mucosal erosions, with Toxic Epidermal Necrolysis being the most severe. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis is a disease of keratinocytes and therefore any squamous cell epithelium is at risk. This includes the cornea, conjunctiva, oral mucosa, esophagus, urethra, and anal canal. This skin reaction is typically drug-induced and has a very poor prognosis. We present four different Stevens-Johnson Syndrome patients who managed solely in the burn intensive care unit at our facility. The mainstay of treatment included supportive care with an emphasis on fluid and electrolyte replacement. Transfer of patients to the burn unit is not the current standard of care, however could decrease the mortality and morbidity of patients. As seen in our centers burn intensive care unit patients only had a mortality rate of 17% over 5 years. Management of Stevens-Johnson Syndrome in the burn intensive care unit with a comprehensive interdisciplinary wound care team rather than solely dermatological intervention may improve outcomes.

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Introduction. Pentazocine, a synthetic opioid with partial agonist and antagonist activity administered by parenteral injection, was used clinically in the 1970s. Dermatologic complications at injection sites were reported soon after its introduction. These complications are thought to be underreported. Many well-documented cases describe the development of fibrosis and calcinosis at the site of parenteral pentazocine injections, but few reports document management or successful treatment of the long-term sequelae of these manifestations. Case Report. The successful use of STSG for the treatment of chronic nonhealing ulcers secondary to pentazocine-induced cutaneous fibrosis in a 78-year-old male is presented. In the early 1970s, he was started on 3-times-daily intramuscular pentazocine injections to treat pain secondary to ulcerative colitis. He injected himself in the proximal thighs and buttocks for a period of approximately 10 years. He gradually developed severe soft tissue calcifications of both buttocks and anterior thighs. In the mid-to-late 1980s, the pentazocine injections were discontinued. The diffuse sclerosis and disfiguring fibrosis remained. Conclusions. This case underscores the lasting effects of pentazocine-induced cutaneous sclerosis and fibrosis, with cutaneous complications manifesting in this patient even decades after use. It also highlights the novel use of STSG as a treatment strategy for these cutaneous complications.

Spontaneous intramural hematoma of the colon is very rare and is typically induced by anticoagulant therapy, bleeding diathesis, or abdominal trauma. The symptoms are nonspecific and can vary from mild, crampy abdominal pain to hemorrhagic shock. The duodenum and small bowel are the most common sites of involvement. Spontaneous intramural colonic hematoma is a relatively rare cause of small bowel obstruction, only seen in 1 out of 2500 hospitalized patients with a history of anticoagulant use. We present a rare case of spontaneous colonic intramural hematoma leading to full thickness bowel lumen compromise resulting in small bowel obstruction. Additionally, this patient presented with secondary polycythemia due to chronic hypoxemia with no prior history of anticoagulant use before hospital admission and heparin drip use.