Stevens‐johnson syndrome: Twenty‐three cases and their otolaryngologic significance

Abstract

Stevens-Johnson syndrome is a symptom complex characterized by mucosal, ocular, and cutaneous lesions. Prodromal symptoms of upper respiratory infection or pharyngitis are most common. These are followed by target lesions of skin, sloughing of musous membranes, and ocular inflammation. Twenty-three cases are presented. Most patients (61 percent) were between 10 and 39 years of age. Relapses occurred in three patients. Five patients developed pneumonia, and there were two fatalities. Over one-half of the patients had serious ocular complications. The etiology of this syndrome is uncertain. Multiple allergic factors, drugs (especially long-acting sulfonamides), and infectious agents (most recently mycoplasma pneumoniae) have been implicated. This study does not support any single cause. The use of systemic steroids is generally accepted by most authors. The death rate in this study (10 percent) is essentially unchanged from early reports on patients without steroid therapy. The complications rate directly attributable to steroids is significant in this study group. The major complications of this syndrome are ocular. Aggressive topical management of ocular inflammation is required; however, the morbidity rate remains high despite these measures. The otolaryngologist should be aware of this syndrome as the early symptoms, and the acute complications may require his awareness of the natural and treated courses of this disease.

Laryngeal involvement in toxic epidermal necrolysis

“…Others have reported a significant rate of steroid therapy complications, including upper gastrointestinal hemorrhage and psychosis. 2,6 Stevens-Johnson syndrome and toxic epidermal necrolysis represent the most severe form of mucocutaneous reactions to drug therapy. Treatment remains largely supportive, with the use of systemic corticosteroids still controversial.…”

“…TEN represents the most severe variant with the highest mortality 'rate, depending on the percentage body surface area used for differentiation between TEN and SJS. 1,2,[4][5][6][7] The overall reported mortality with EM is nearly 0%, whereas SJS has a mortality of 5% to 15% and TEN has a mortality of 25% to 30%.3,8…”

Blindness, Anonychia, and Oral Mucosal Scarring as Sequelae of the Stevens‐Johnson Syndrome

“…Moreover, chronic inflammation due to trichiasis and keratinization of the conjunctivae caused significant morbidity and necessitated surgical procedures quite apart from the corneal changes. Additional ophthalmic complications of SJS have been summarized elsewhere (2)(3)(4).…”

Differential Diagnosis of Superficial Ulcerations of the Oral Mucosa

“…In more than one half of the patients, serious ophthalmologic complications develop, including corneal ulceration, trichiasis, and symblephara. 7 The etiology is unknown in 80% of the cases, but drug allergy (eg, to sulfonamides, erythromy- cin, penicillin, tetracycline, salicylates, and diphenylhydantoin) has been demonstrated in 20%. A relationship to recurrent herpetic stomatitis has also been noted.…”