Overview
What is Stevens-Johnson syndrome (SJS) and what are the classifications of severity?
What are the prodromal symptoms of Stevens-Johnson syndrome (SJS)?
What are the symptoms of Stevens-Johnson syndrome (SJS) and how are cutaneous lesions characterized?
What are the signs of mucosal involvement in Stevens-Johnson syndrome (SJS)?
What ocular signs may be noted on slit-lamp exams in Stevens-Johnson syndrome (SJS)?
What are the ocular exam findings in Stevens-Johnson syndrome (SJS)?
How is Stevens-Johnson syndrome (SJS) treated?
What is the recommended treatment of nonviable epidermis in Stevens-Johnson syndrome (SJS)?
What is the initial treatment of acute ocular manifestations in Stevens-Johnson syndrome (SJS)?
What is Stevens-Johnson syndrome (SJS) and how does the presentation vary?
What is the etiology of Stevens-Johnson syndrome (SJS)?
Where can patient education information on Stevens-Johnson syndrome (SJS) be found?
What is the role of cytokines in the pathophysiology of Stevens-Johnson syndrome (SJS)?
What are the etiologic categories of Stevens-Johnson syndrome (SJS)?
Which viral diseases have been associated with Stevens-Johnson syndrome (SJS)?
Which viruses are associated with the development of Stevens-Johnson syndrome (SJS) in children?
What are the bacterial causes of Stevens-Johnson syndrome (SJS)?
What are the fungal and protozoal causes of Stevens-Johnson syndrome (SJS)?
What are the most common drug-related causes of Stevens-Johnson syndrome (SJS)?
Which anticonvulsants may cause Stevens-Johnson syndrome (SJS)?
Which antiretroviral drugs may cause Stevens-Johnson syndrome (SJS)?
Which drugs are less commonly implicated as a cause of Stevens-Johnson syndrome (SJS)?
What are considerations regarding genetic factors in the etiology of Stevens-Johnson syndrome (SJS)?
What is the epidemiology of Stevens-Johnson syndrome (SJS)?
Does Stevens-Johnson syndrome (SJS) have a racial predilection?
Is Stevens-Johnson syndrome (SJS) more common in men or women?
What are the age-related demographics of Stevens-Johnson syndrome (SJS)?
What is the prognosis of Stevens-Johnson syndrome (SJS)?
What are the secondary negative prognostic factors in Stevens-Johnson syndrome (SJS)?
What is the prognosis of Stevens-Johnson syndrome (SJS)?
What long-term complications are associated with Stevens-Johnson syndrome (SJS)?
Presentation
How is the initial presentation of Stevens-Johnson syndrome (SJS) characterized?
What does a history of fever or localized worsening suggest in Stevens-Johnson (SJS) syndrome?
What causes recurrences of Stevens-Johnson syndrome (SJS)?
What are the prodromal symptoms of Stevens-Johnson syndrome (SJS)?
How is the rash characterized in the initial presentation of Stevens-Johnson syndrome (SJS)?
Where on the body are lesions found in Stevens-Johnson syndrome (SJS)?
Which ocular symptoms are associated with Stevens-Johnson syndrome (SJS)?
What is the role of drug exposure in the history for Stevens-Johnson syndrome (SJS)?
How are lesions characterized in the physical exam in Stevens-Johnson syndrome (SJS)?
Which body parts are most commonly affected by lesions in Stevens-Johnson syndrome (SJS)?
How is mucosal involvement characterized in Stevens-Johnson syndrome (SJS)?
Can a diagnosis of Stevens-Johnson syndrome (SJS) be established in the absence of skin lesions?
Which physical signs may be noted on exam in Stevens-Johnson syndrome (SJS)?
Which ocular signs may be noted on slit-lamp exam in Stevens-Johnson syndrome (SJS)?
What are the nonocular complications of Stevens-Johnson syndrome (SJS)?
Which ocular, genitourinary, and cutaneous complications occur in Stevens-Johnson syndrome (SJS)?
DDX
What are the differential diagnoses for Stevens-Johnson Syndrome?
Workup
Which procedure is needed for a definitive diagnosis of Stevens-Johnson syndrome (SJS)?
Which serum levels are typically elevated in Stevens-Johnson syndrome (SJS)?
How are skin and blood cultures used in the workup of Stevens-Johnson syndrome (SJS)?
Which skin biopsy findings are associated with Stevens-Johnson syndrome (SJS)?
Which procedures and imaging studies are indicated in the workup of Stevens-Johnson syndrome (SJS)?
How are typical histopathologic findings characterized in Stevens-Johnson syndrome (SJS)?
What are dermal and epidermal histopathologic findings in Stevens-Johnson syndrome (SJS)?
What is the role of CD8+ T cells in Stevens-Johnson syndrome (SJS)?
What does immunohistology of the conjunctiva demonstrate in Stevens-Johnson syndrome (SJS)?
What is the role of vivo confocal microscopy in the workup of Stevens-Johnson syndrome (SJS)?
Treatment
How is Stevens-Johnson syndrome (SJS) treated?
What approach should paramedics take in the treatment of Stevens-Johnson syndrome (SJS)?
How are oral lesions managed in Stevens-Johnson syndrome (SJS)?
How are skin lesions treated in Stevens-Johnson syndrome (SJS)?
What pulmonary care is indicated in the treatment of Stevens-Johnson syndrome (SJS)?
How is the risk of nosocomial infection reduced in Stevens-Johnson syndrome (SJS)?
What are the first signs of sepsis in Stevens-Johnson syndrome (SJS) and what is the treatment?
How is an antibiotic selected for infection control in Stevens-Johnson syndrome (SJS)?
What is the criterion standard in the treatment of Stevens-Johnson syndrome (SJS)?
Why are randomized studies with a placebo control lacking in Stevens-Johnson syndrome (SJS)?
Which therapeutic modalities have been advocated in the treatment of Stevens-Johnson syndrome (SJS)?
What is the role of systemic steroids in the treatment of Stevens-Johnson syndrome (SJS)?
What is the role of cyclosporine in the treatment of Stevens-Johnson syndrome (SJS)?
What is the role of IVIG in the treatment of Stevens-Johnson syndrome?
What is the initial treatment of acute ocular manifestations in Stevens-Johnson syndrome (SJS)?
How is ocular integrity preserved in Stevens-Johnson syndrome (SJS)?
When is visual rehabilitation indicated in Stevens-Johnson syndrome (SJS)?
What is the treatment for mild chronic superficial keratopathy in Stevens-Johnson syndrome (SJS)?
How are chronic ocular manifestations of Stevens-Johnson syndrome (SJS) treated?
What consultations should be considered for patients with Stevens-Johnson syndrome (SJS)?
What is the long-term management of Stevens-Johnson syndrome (SJS)?
Guidelines
What are the treatment guidelines for eye involvement in Stevens-Johnson syndrome (SJS)?
Medications
What is the goal of pharmacotherapy in Stevens-Johnson syndrome (SJS)?
What is the role of systemic corticosteroids in the treatment of Stevens-Johnson syndrome (SJS)?
What is the role of human IVIG in the treatment of Stevens-Johnson syndrome (SJS)?
-
A patient with severe eye involvement associated with Stevens-Johnson syndrome. Note corneal neovascularization and conjunctivalization of the ocular surface.
-
Epithelial defect of the cornea with neovascularization and surface conjunctivalization.
-
Note extensive sloughing of epidermis from Stevens-Johnson syndrome. Courtesy of David F. Butler, MD.
-
Sheetlike desquamation on the foot in a patient with toxic epidermal necrolysis. Courtesy of Robert Schwartz, MD.
-
Hemorrhagic crusting of the mucous membranes in toxic epidermal necrolysis. Similar lesions are seen in Stevens-Johnson syndrome. Courtesy of Robert Schwartz, MD.
-
Note early cutaneous slough with areas of violaceous erythema.
-
Extensive sloughing on the face.
-
Note the presence of both 2-zoned atypical targetoid lesions and bullae.
-
Extensive blistering and sloughing on the back.
-
Extensive sloughing on the back.
-
Note extensive sloughing.
-
Low-power view showing full-thickness epidermal necrosis.