Steven-Johnson

Syndrome

Allergy Immunology subdivision

Department of Pediatrics
Sumatera Utara University
Medical Faculty / H. Adam Malik Hospital

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Steven-Johnson Syndrome
• Drug induced problem

• Found by Stevens & Johnson (1922)

• Acute, self-limited disease, but high

morbidity and potentially life-threatening

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Etiology
• Immune-complex-mediated
hypersensitivity disorder

• May caused by : drugs, viral infection

( eg : HIV ) (eg:Mycoplasma pneumoniae)
& malignancies or idiopathic

• Predispose factors : autoimmune

disorders ( SLE ), HLA-Linked, genetic

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Etiology…………………
• Drugs such as :

Carbamazepin (most)

DPT vaccine

Phenoxymethylpenicilline

Amoxycilline

Metamizole natrium

Acetylsalicylate acid
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 Clinical Manifestations
• Vesicobulous lesion :
Central
Necrosis
Erythematous Vesicles Bullae
macules

Area denudation : face, trunk & extremities

• Severe purulent conjunctivitis
• Severe stomatitis with extensive mucosal
necrosis
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Laboratory
No specific laboratory abnormalities
• Leucocytosis
• Elevated erythrocyte sedimentation rate
• Elevated liver transaminase levels
• Decreased serum values
• Skin biopsy

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 Management
• Supportive & symptomatic

• Ophthalmologic consultation : occular-

corneal scarring (vision loss and
symblepharon)

• Oral lesion: mouthwashes & glycerin swabs

• Observed vaginal lesions

• Topical pain/anesthetic reliefer:

dipenhydramine, dyclonine, viscous lidocaine7
Management……………….
• Compressed denude skin lessions with
saline/burowi solution

• Antibiotic for secondary bacterial

infections

• Corticosteroid (dexamethasone) :
1mg/kg/day (loading dose), then 0,2-0,5
mg/kg/day

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Management ……………
• May require admission to intensive care
unit (ICU), IV fluids, nutritional support,
wound & burn care, daily saline/burowi
solution compress, parafin gauze or
hydrogel dressing of denude areas, saline
compress of eyelids/lips/nose, urinary
cathetherization

• Daily occular infection examination,

systemic antibiotics (urinary/cutaneous
infections).
• Bacterimiae may cause of death 9
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