Gomes Ferreira Sérgio, Fernandes Luís, Santos Sara, Ferreira Sofia, Sequeira Joana
Internal Medicine, Hospital São Sebastião, Centro Hospitalar Entre o Douro e Vouga, Santa Maria da Feira, PRT.
Cureus. 2024 Jan 28;16(1):e53122. doi: 10.7759/cureus.53122. eCollection 2024 Jan.
Stevens-Johnson Syndrome (SJS), a severe mucocutaneous hypersensitivity reaction primarily triggered by drugs, poses a low-incidence, high-mortality challenge. This report explores its clinical nuances and emphasizes supportive care as the mainstay of treatment. A 74-year-old female, burdened with a complex medical history, presented with a non-pruritic macular rash escalating to skin and oral mucosal involvement. A recent introduction of dipyrone (metamizole) implicated drug-induced SJS. Histopathological confirmation guided treatment involving supportive care, corticosteroids, and wound care, resulting in clinical improvement. The case underscores the significance of histopathological confirmation and thorough medication history in navigating SJS complexities, especially in patients with comorbidities like connective tissue disease. A successful multidisciplinary approach and the decision for post-discharge monitoring highlight the intricate management challenges. This case illuminates the intricate interplay of medication-induced hypersensitivity, comorbidities, and management challenges in SJS. Optimal outcomes require prompt diagnosis, trigger identification, and a multidisciplinary treatment approach, emphasizing ongoing research and clinical vigilance.
史蒂文斯 - 约翰逊综合征(SJS)是一种主要由药物引发的严重皮肤黏膜超敏反应,是一种低发病率、高死亡率的挑战。本报告探讨其临床细微差别,并强调支持性护理是治疗的主要手段。一名74岁女性,有复杂的病史,最初出现非瘙痒性黄斑皮疹,随后发展为皮肤和口腔黏膜受累。最近使用的安乃近(甲氨唑)被认为是药物性SJS的诱因。组织病理学确诊后,治疗包括支持性护理、皮质类固醇和伤口护理,临床症状得到改善。该病例强调了组织病理学确诊和详尽用药史在应对SJS复杂性方面的重要性,尤其是对于患有结缔组织病等合并症的患者。成功的多学科方法以及出院后监测的决定凸显了复杂的管理挑战。该病例阐明了药物性超敏反应、合并症和SJS管理挑战之间的复杂相互作用。最佳治疗效果需要及时诊断、确定诱因以及采取多学科治疗方法,强调持续研究和临床警惕性。