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Show Notes

Episode Produced by Audrey Bree Tse, MD

• Rash with dysuria should raise concern for SJS with associated urethritis
  • Dysuria present in a majority of cases
• SJS is a mucocutaneous reaction caused by Type IV hypersensitivity
  • Cytotoxic t-lymphocytes apoptose keratinocytes → blistering, bullae formation, and sloughing of the detached skin
• Disease spectrum
  • SJS =
  • TEN = >30% TBSA
  • SJS/ TEN Overlap = 10-30% TBSA
• Incidence is estimated at around 9 per 1 million people in the US
• Mortality is 10% for SJS and 30-50% for TEN
  • Mainly 2/2 sepsis and end organ dysfunction.
• SJS can occur even without a precipitating medication
  • Infection can set it off especially in patients with risk factors including HIV, lupus, underlying malignancy, and genetic factors
  • SATAN for the most common drugs
    • Sulfa, Allopurinol, Tetracyclines, Anticonvulsants, and NSAIDS
  • Anti-epileptics include carbamazepine, lamictal, phenobarb, and phenytoin
• Can have a curious course
  • Hypersensitivity reaction can develop while taking medication, or even one to four weeks after exposure
  • In pediatric population, mycoplasma pneumonia and herpes simplex have been identified as precipitating infections
• Patients often have a prodrome 1-3 days prior to the skin lesions appearing
  • May complain of fever,