Stevens-Johnson Syndrome without Skin Lesions: A Rare and Clinically Challenging Disease in the Urgent Setting.
Stevens-Johnson syndrome, toxic epidermal
necrolysis, and erythema multiforme are
life threatening diseases causing
mucocutaneous eruptions and can be
difficult to manage medically. When oral tissues
are involved, airway
management can be of critical importance.
Fluid and electrolyte imbalance are
common and protocols to
prevent secondary infection are initiated. All
three conditions are rapidly
evolving. Stevens-Johnson
syndrome is more commonly
associated with Mycoplasma
pneumoniae in the
pediatric population and drug hypersensitivity
in adults, whereas
erythema multiforme is
mostly associated with herpes simplex virus in the
adult population.
These diseases are T-cell-mediated immune
reactions, thought to represent a
spectrum of the same disease. Clinical and
immunohistochemical techniques are
capable of differentiating
Stevens-Johnson syndrome from
erythema multiforme and provide insight into the
possible underlying pathology creating the disease.
Rare cases of Stevens-Johnson syndrome
without skin manifestations have
been associated with Mycoplasma
pneumoniae and predominantly
occur in males. In-hospital
management is recommended
to provide airway support,
maintain fluid intake, electrolyte balance, obtain
multi-speciality consultation, and to perform
diagnostic testing. We describe a case of a 14 year old
male with atypical Stevens-Johnson
syndrome and a review of the literature.
Emerg Med Open J. 2015; 1(2): 22-30. doi: 10.17140/EMOJ-1-106
