Stevens-Johnson Syndrome

80. Stevens-Johnson Syndrome



Definition


Stevens-Johnson syndrome (SJS) is a hypersensitivity disorder mediated by immune-complex formation. It is a potentially fatal systemic disorder that is a severe type of erythema multiforme. SJS is also known as “erythema multiforme major.”


Incidence


The frequency of SJS is estimated to be about 1.2:1,000,000 to 6:1,000,000. This disorder has been reported in all racial and ethnic groups and affects both sexes about equally over all age groups.


Etiology


Stevens-Johnson syndrome is classified into four categories (see box below). Approximately half of all cases of SJS have been linked to ingestion of a medication. To date, more than 100 different medications have been linked to the development of SJS (see box on pp. 321-322). The second most common cause result from infectious agents/vectors (see box on p. 321). As many as 25% of SJS cases are deemed idiopathic, while the smallest number of SJS cases have been associated with some form of carcinoma and/or lymphoma.



Four Etiologic Categories of Stevens-Johnson Syndrome






1. Infectious


2. Drug-induced


3. Malignancy-related


4. Idiopathic







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Stevens-Johnson Syndrome. Severe oral and skin involvement.



Infectious Causes of Stevens-Johnson Syndrome






• Adenoviruses


• Calmette-Guérin virus


• Deep fungal infections


• Enterobacter species


• Enteroviruses


• Herpes simplex virus


• Influenza


• Measles


• Mumps


Mycobacterium pneumoniae


Mycobacterium tuberculosis


Streptococcus pneumoniae


• Syphilis


• Typhoid fever



Drugs Associated with the Development of Stevens-Johnson Syndrome



Sulfonamides






• Pyrimethamine-sulfadoxine (Fansidar)


• Sulfadiazine (Coptin)


• Sulfasalazine (Azulfidine)


• Trimethoprim-sulfamethoxazole


Anticonvulsants






• Carbamazepine


• Phenobarbital


• Phenytoin (Dilantin)


Others






• Acetaminophen


• Allopurinol (Aloprim, Zyloprim)


• Aminopenicillins


• Amithiozone


• Amoxapine (Asendin)


• Barbiturates


• Cephalosporins


• Chlormezanone (Trancopal)


• Clobazam


• Diclofenac


• Fluvoxamine (Luvox)


• Hydantoins


• Imidazole antifungals


• Indapamide (Lozol)


• Lamotrigine (Lamictal)


• Macrolides


• Mianserin


• Oxicam


• Nonsteroidal anti-inflammatory drugs (NSAIDs) (piroxicam, tenoxicam)


• Propionic NSAIDs


• Propranolol (Inderal, InnoPran XL)


• Pyrazolone derivatives (i.e., dipyrone)


• Quinolones


• Salicylates


• Sertraline (Zoloft)


• Tetracycline


• Tiapride

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Aug 5, 2016 | Posted by in ANESTHESIA | Comments Off on Stevens-Johnson Syndrome

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