UMEM Educational Pearls

Title: What's the Diagnosis? Case by UMEM alumni Dr. Ari Kestler

Posted: 6/30/2014 by Haney Mallemat, MD
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49 year-old female on trimethoprim/sulfamethoxazole presents with a rash & lesions on her oral mucus membranes. What's the diagnosis?

Answer: Steven-Johnson Syndrome (SJS)

SJS: involvement of <10% body-surface area (BSA) PLUS mucus membrane involvement (e.g., ocular, oral, genital)
Toxic Epidermal Necrolysis (TEN): involvement of >30% BSA PLUS mucus membrane involvement
Occurs secondary to immune-complex hypersensitivity reaction from viral, bacterial, or chemical exposure (Sulfonamides > PCN > Cephalosporins)
Management:
- Remove possible trigger(s)
- Manage like a severe burn (supportive care with hemodynamic support, electrolyte management, analgesia)
- Strongly consider admission to an ICU

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