Steven Jhonson Syndrome

Drug induced problem

Found by Stevens & Johnson (1922)

Acute, self-limited disease, but high morbidity and potentially life-threatening


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

Drugs such as :

Carbamazepin (most)

DPT vaccine



Metamizole natrium

Acetylsalicylate acid

Clinical Manifestations

Vesicobulous lesion :

Area denudation : face, trunk & extremities

Severe purulent conjunctivitis

Severe stomatitis with extensive mucosal necrosis


No specific laboratory abnormalities


Elevated erythrocyte sedimentation rate

Elevated liver transminase levels

Decreased serum values

Skin biopsy


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 lidocaine

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

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



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