UMEM Educational Pearls


49 year-old female on trimethoprim/sulfamethoxazole presents with a rash & lesions on her oral mucus membranes. What's the diagnosis?


Answer: Steven-Johnson Syndrome (SJS)

  • SJS: involvement of <10% body-surface area (BSA) PLUS mucus membrane involvement (e.g., ocular, oral, genital)
  • Toxic Epidermal Necrolysis (TEN): involvement of >30% BSA PLUS mucus membrane involvement
  • Occurs secondary to immune-complex hypersensitivity reaction from viral, bacterial, or chemical exposure (Sulfonamides > PCN > Cephalosporins)
  • Management:
    • Remove possible trigger(s)
    • Manage like a severe burn (supportive care with hemodynamic support, electrolyte management, analgesia)
    • Strongly consider admission to an ICU


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