SYNDROM STEVEN JOHNSON

Nurbaeti Bakhtiar (C11108145) Faturrahman (

CASE REPORT
Nama : Mr. H. Umur : 52 tahun Alamat : Jl. Abubakar Lambogo No. 207 A Tanggal masuk : 5 Juni 2012

ANAMNESIS
Keluhan Utama: Luka pada bibir, lidah, dan kemaluan Brief anamnesis: Lession : since a week before admission Erythema : 2 weeks before admission then becomes hiperpigmentation 3 days ago Subfebril Pain lession Treatment history : isoniazid, rifampisin, etambutol for 5 days before complaints arise

PRESENT STATUS
General condition : moderate Hygiene : average Vital Signs: BP : 110/90 mmHg Pulse : 92x/min RR : 20x/min Temp : 37,5o C Conciousness : composmentis

DERMATOVENEROLOGY
Location : oris, tongue, and genitalia Size : plakat Efflorescency : makula

LABORATORY RESULT
WBC : 2x103 Hb : 7 RBC : 2,66 x106 PLT : 31x 10 3

FURTHER EXAMINATION
CBC count with differential Biopsy by showing eosinophils in morbilliform eruptions or numerous neutrophils

RESUME
A woman 29 years old, come to hospital with chief complaint of lession of the lip and mouth. The complaint started since a week before admission. Erythmatic lession appears 2 weeks before then becomes hiperpigmentation 3 days ago. Treatment history : isoniazid, rifampisin, etambutol for 5 days before complaints arise

DIAGNOSIS

Syndrom Steven Johnson

TREATMENT

SYNDROME STEVEN JOHNSON

DEFINISI SSJ : kelainan klt termasuk eritema multiformis mayor kulit, selaput lendir/ mukosa di orifisium, mata dan organ-organ tubuh lain Keadaan umum bervariasi : ringan sampai berat
MDL/PKD/Jan/2006

ETIOLOGY

Drug eruptions may be divided into immunologically mediated reactions. Medications that are known for causing immunologically cutaneous reactions include antimicrobial agents, NSAIDs, anticonvulsants, and psychotropic agents.

PATHOGENESIS

Type I is immunoglobulin E (IgE)dependent reactions, which result in urticaria, angioedema, and anaphylaxis (see the image below). Urticaria. Type II is cytotoxic reactions, which result in hemolysis and purpura (see the image below).Oral ulcerations in a patient receiving cytotoxic therapy. Type III is immune complex reactions, which result in vasculitis, serum sickness, and urticaria. Type IV is delayed-type reactions with cell-mediated hypersensitivity, which result in contact dermatitis, exanthematous reactions, and photoallergic reactions

CLINICAL MANIFESTATION
Mucous membrane erosions Blisters Confluent erythema Angioedema and tongue swelling Palpable purpura Skin necrosis Lymphadenopathy High fever, dyspnea, or hypotension

DIAGNOSIS From the history of chief complaints, clinical finding, and treatment history before complaints arise. Biopsy Histopathology of an exanthematous drug eruption may show both superficial and deep perivascular inflammatory cell infiltrates, eosinophils in the infiltrate.

DIFFERENTIAL DIAGNOSIS

Erythema Multiforme Stevens-Johnson Syndrome

DRUG ERUPTION

ERYTHEMA MULTIFORME

The initial lesion is a dull-red, purpuric macule or urticarial plaque that expands slightly to a maximum of 2 cm over 24-48 hours. In the center, a small papule, vesicle, or bulla develops, flattens, and then may clear.

STEVENS-JOHNSON SYNDROME

The rash can begin as macules that develop into papules, vesicles, bullae, urticarial plaques, or confluent erythem, may be confined to any one area of the body, most often the trunk. Mucosal involvement may include erythema, edema, sloughing, blistering, ulceration, and necrosis Conjunctivitis

TREATMENT Antihistamines Corticosteroids Systemic steroids are used in persons with hypersensitivity

PROGNOSIS