A case of Stevens-Johnson disease (erythemamultiforme bullosa) treated with penicillin

Abstract

A case of a 9-year-old boy with Stevens-Johnson syndrome is presented. 1.In the past this disease in its typical, severe form was marked by but oneserious sequela, that is, partial or total blindness due to eye involvement, possibly by bacterial agents. Staphylococcus aureus and sometimes mixed streptococcus and staphylococcus, are the most common bacteria cultured from the eye. 2.This patient was treated with sulfadiazine and penicillin, locally andparenterally, with decided improvement, which seemed to be related in dramatic time sequence to the use of penicillin, especially locally. 3.In a tabulation of twenty-one cases of erythema multiforme bullosawith mucous membrane lesions of varying severity, only five patients received adequate doses of sulfonamide or other antibacterial agents. In the seven most severe cases of the remaining sixteen, those that were typical of Stevens-Johnson disease, in which therefore, there was either purulent or membranous conjunctivitis, the patients were left with total or partial blindness. 4.It is suggested that such therapy as herein described, or modifications thereof, be used in the future to avoid eye complications. We do not know that penicillin is a “specific”; it may be, rather, an antibacterial agent useful against complications. Sulfonamides alone, in the past, prevented blindness, as did local Metaphen. 5.Six months after the onset of illness this patient was readmitted withacute rheumatic polyarthritis. A case of a 9-year-old boy with Stevens-Johnson syndrome is presented. 1.In the past this disease in its typical, severe form was marked by but oneserious sequela, that is, partial or total blindness due to eye involvement, possibly by bacterial agents. Staphylococcus aureus and sometimes mixed streptococcus and staphylococcus, are the most common bacteria cultured from the eye. 2.This patient was treated with sulfadiazine and penicillin, locally andparenterally, with decided improvement, which seemed to be related in dramatic time sequence to the use of penicillin, especially locally. 3.In a tabulation of twenty-one cases of erythema multiforme bullosawith mucous membrane lesions of varying severity, only five patients received adequate doses of sulfonamide or other antibacterial agents. In the seven most severe cases of the remaining sixteen, those that were typical of Stevens-Johnson disease, in which therefore, there was either purulent or membranous conjunctivitis, the patients were left with total or partial blindness. 4.It is suggested that such therapy as herein described, or modifications thereof, be used in the future to avoid eye complications. We do not know that penicillin is a “specific”; it may be, rather, an antibacterial agent useful against complications. Sulfonamides alone, in the past, prevented blindness, as did local Metaphen. 5.Six months after the onset of illness this patient was readmitted withacute rheumatic polyarthritis.