Stevens-Johnson

Syndrome

IDENTITAS PASIEN

Name : Mr R
Gender : Male
Age : 34 y.o.
Marital Status : Married
Religion : Islam
Address : Ternate
Ethnicity : Ambon
Nationality : Indonesia
Occupation : Entrepreneur

ANAMNESIS
Chief Complaint: Wound in the
lips, eyes and penis
Chief Anamnesis:
First experienced 2 weeks ago, at
first there were only a red spot
appeared around hands and body
and then a blister appear on lips and
eyes

 Patient treated in RSUD Ternate with

high fever, and treated with paracetamol
and injection (unknown). 3 days later a
red spot appeared and diagnosed morbili
by doctor. Doctor continued paracetamol
treatment and 9 days later, blister were
present in lips,eyes, and penis which
were accompanied by swelling and pus,
the whole body was blackened as well

 Patient feels no improvement while

treated in the hospital. So, the
patient ask to leave hospital to find
another doctor. There, he was
diagnosed with Stevens Johnson
Syndrome and referred to Wahidin
Sudirohusodo Hospital

 History of drug allergy (-)

History of previous illness:
Patient is currently on MDT for 2
months

General Status

General Condition : Severely ill

Consciousness : Compos mentis
Nutritional Status : Deficient
Hygiene : Deficient
Vital Sign :
- Blood Pressure : 130/70 mmHg
- Pulse: 96 x/minute
- Breathing
: 22x/minute
- Temperature : 38,2C

Physical Examination
Head
: Anemia (+/+), Ikterus
(-/-),
Heart/Pulmonary : normal
Abdomen
: Ascites (-)
Extremity
: Edema lower
extremity (-)
Lymph Node
: No Enlargement

Dermatology Status
Location
regio orbitalis D/S , regio labialis, dan
regio genitalis
Effloresence
Orbita : Ulkus, hemorrhagic crust
Labia : Erotion, excoriation,
hemorrhagic crust
Genital : Ulkus, madidans with pus

Results of laboratory tests

RBC : 0,99x106/mm3
HGB : 4,3 gr/dl
HCT : 11,3 %
MCV : 113 um
MCH : 42,8 pg
MCHC : 37,5 gr/dl
PLT : 53 x 103 / ml3

GDS : 119 mg/dl

Ureum : 72 mg/dl
Creatinin : 1,50 mg/dl
Bilirubin total : 13,73 mg/dl
SGOT : 47 u/l
SGPT : 38 u/l
Albumin : 2 g/dl

DIAGNOSIS

Swollen eye and blister

DIAGNOSIS

Blackened skin and peeled

DIAGNOSIS

Wound in penis and pus

Terapi

Resume
Man 34 y.o. comes with a wound in
eyes, lips and penis
Patient treated in hospital with high
fever, and treated with paracetamol
and injection (unknown). 3 days later a
red spot appeared, 9 days later, blister
were present in lips, eyes, and penis
which were accompanied by swelling
and pus, the whole body was blackened
as well

Patient feels no improvement while

treated in the hospital. So, the patient
ask to leave hospital to find another
doctor. There, he was diagnosed with
Stevens
Johnson
Syndrome
and
referred to Wahidin Sudirohusodo
Hospital

General Status: patient is severely ill,

compos
mentis,
nutritional
status
deficient, hygiene deficient.
Vital Sign: blood pressure 130/70 mmHg,
pulse
96
x/minute,
breathing
22
x/minute, axilla temperature 38,2C.
physical examination reveals reranemia
(+/+)

On skin examination, at orbita

obtained
effloresensi ulcers and
hemorrhagic crusts, the labia obtained
erosion and hemorrhagic crust, and
ulceration of the penis and madidans
with pus.

Thank you

DISCUSSION

DEFINITION
Stevens-Johnson syndrome is a
collection of clinical symptoms of
mucocutaneous eruption characterized
by a triad of disorders of the skin,
mucous orifice, and the eye
accompanied by severe general
symptoms.

ETIOLOGY
Hypersensitivity to infection
virus
bacterium
mycobacteria
Mycoplasma pneumoniae
protozoa
fungi

ETIOLOGY
Immunization / hyposensitization
Diphtheria, pertussis, polio, typhoid,
and measles
hyposensitization pollen, poison ivy
Sensitivity to food, drugs, neoplasms,
connective tissue disease (SLE).

EPIDEMIOLOGY
Incidence 1,2 to 6 per million personyears.
Common in adults > 40 years old
Risk factor for HLA-B12, SLA, and HIV
disease

PATHOGENESIS
Pathogenesis of SJS is only partially
understood.
It is viewed as a cytotoxic immune reaction
aimed at the destruction of keratinocytes
expressing foreign (drug-related) antigens.
Epidermal injury is based on the induction
of apoptosis.
The nature of the antigens that drive the
cytotoxic cellular immune reaction is not
well understood.

THERAPY
Gentamicin injection 80 mg iv/12 Hours
(1-1,5 mg/kgBB/).
Metronidazole infusion 0-0-1/24 hours/iv.
Improvements fluid balance, electrolyte,
and protein.
Cleaning debris only in the necrotic skin.

Treating concomitant infections,

including sepsis.

THERAPY
Identifying and stopping the drug
causes
Care and treatment of eye
disorders
Special care in place to prevent
infections

DIFFERENTIAL DIAGNOSIS

Eritem Multiformis

Toxic Epidermal Necrolysis

PROGNOSIS
Prognosis is good if regular
treatment.
Recurrence can occur if patients
do not discontinue the drug that
triggered.