Day :
Keynote Forum
Wisam Alhathlol
General practitioner in Security of forces Hospital, Hail, Saudi Arabia
Keynote: Early Diagnosis of Stevens-Johnson Syndrome in Dental Clinic
Biography:
Abstract:
Stevens-Johnson syndrome (SJS) is a mucocutaneous illness in which the patients are usually presented with a spectrum of mucocutaneous rash involving the oral, ocular, or genital mucosa. It is associated with several factors including the commonly used medications in clinical practice. In this report, we describe a case of SJS that developed after exposure to antibiotics in a patient who presented with acute oral lesions to dental emergency clinic. Introduction: Stevens–Johnson Syndrome (SJS) is a rare mucocutaneous condition. It has been related to several risk factors including medications. It is commonly presented with skin rash that usually involve oral mucosa or conjunctivae but it could be life-threatening in rare cases (1). Stevens– Johnson syndrome is part of a spectrum of diseases ranging from SJS when presented with less than 10% skin detachment to toxic epidermal necrolysis when presented with greater than 30% skin detachment (2). Cases of SJS have been increasingly reported as unfavorable drug effects, yet the exact pathology is not entirely understood (3). With use of commonly prescribed medications, such as antibiotics, SJS as an adverse drug reaction represents a continuing challenge for the emergency health providers. Case Report: A 37-year-old Saudi male presented to dental emergency clinic of Riyadh Elm University complaining of burning sensation in the mouth and difficulty in swallowing with diagnosed oral candidiasis. Five days prior to this visit he was prescribed antibiotics by private clinic that resulted in another attack of burning sensation followed by more difficulty in swallowing and generalized skin rash. Medical History: Fever since 2 days, joint pain and blurred vision since 2 days with no history of any kind of allergy. The family history was unremarkable. At clinical presentation: He was sick and febrile with a temperature of 40 C. General examination showed enlarged cervical lymph nodes, skin rash over the upper limbs (Figure 1). There was no joints swelling. Local examination showed blisters on the floor of the mouth and buccal mucosa with scattered oral ulcers with erythematous base (Figure 2), and coated tongue (Figure 3). The purpose of this report was to highlight the early signs and symptoms of SJS, which may have been overlooked and misattributed to other causes. Differential Diagnosis: Herpes simplex virus (HSV), bullous pemphigoid, HIV and autoimmune vasculitis. Management at our center: 2 Initially he was treated with topical betamethasone for 14 days, topical chlorhexidine10 days and nystatin suspension: 100,000 units PO. The patient was reviewed 3 weeks later in our clinic and his clinical features showed afebrile, active with improved general and local clinical manifestations. (Figure 4). Management at referral center: He was referred to an infectious disease consultant for second opinion in another hospital. Laboratory investigations showed negative results in pan cultures, HIV and hepatitis screening. The diagnosis was mild StevenJohnson syndrome versus immuno-deficiency disorders.