UMEM Educational Pearls


49 y.o. female on Trimethoprim/sulfamethoxazole presents with rash and oral mucus membrane lesions. Diagnosis?


Answer: Steven-Johnson Syndrome

  • Malaise and fever prodrome, followed by erythematous or purpuric macules and plaques
    • <10% body-surface area (BSA) and mucosal membrane involvement (e.g., ocular, oral, genital)
    • Toxic Epidermal Necrolysis defined as >30% BSA involvement
  • Immune-complex hypersensitivity reaction from viral, bacterial, chemical, or drug exposure.
    • Common medications:
      • Antibiotics; Sulfonamides > PCN > Cephalosporins
      • NSAIDs
      • Anti-psychotics
  • Management:
    • Remove possible trigger(s)
    • Treat like burns; supportive care (hemodynamic support, electrolyte management, analgesia)
    • Strongly consider Burn ICU.


French LE. Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. Allergol Int. Mar 2006;55(1):9-16

Schöpf E. Toxic epidermal necrolysis and Stevens-Johnson syndrome. An epidemiologic study from West Germany. Arch Dermatol. 1991;127(6):839.

Roujeau JC. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19):1272.


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