Steven Johnsons Research Articles

Coronavirus-disease-2019-associated Stevens–Johnsons syndrome in a 15-year-old boy: a case report and review of the literature

BackgroundStevens–Johnson syndrome (SJS) is a life-threatening condition characterized by high fever and severe mucocutaneous lesions, often triggered by drugs or infection. During the coronavirus disease 2019 pandemic, there was a marked increase in Stevens–Johnson syndrome cases, but relatively few cases were reported in children. The present article reports a pediatric case of Stevens–Johnson syndrome due to coronavirus disease 2019 infection and provides a review of the most relevant literature.Case presentationA previously healthy 15-year-old Han Chinese boy from China presented to the hospital with oral ulcers, conjunctival hyperemia, and widespread maculopapular rash. He had a history of fever 9 days prior and tested positive for coronavirus disease 2019 infection. Upon admission, his rash and mucosal lesions worsened, with the development of blisters on the fingertips of both hands, ocular pain, photophobia, and erosive lesions on the genital mucosa with exudation. He was diagnosed with Stevens–Johnson syndrome and received treatment with methylprednisolone, intravenous immunoglobulin, and dermatological and mucosal care. The patient’s condition was managed, and the dosage of high-dose intravenous methylprednisolone was tapered down, followed by a transition to oral prednisolone. He was discharged without sequelae.ConclusionWe should be aware that coronavirus disease 2019 infection is associated with the development of Stevens–Johnson syndrome in children and may lead to a wide spectrum of dermatologic presentations. Although Stevens–Johnson syndrome is a relatively rare condition, given its potentially serious consequences, it is crucial to identify it as early as possible and to take appropriate preventive and therapeutic measures to reduce complications and improve the quality of life for patients.

Steven Johnsons Syndrome Induced by Carbamezapene

Steven Johnsons Syndrome Induced by Carbamezapene

Steven Johnsons Syndrome Induced by Carbamezapene

Steven Johnsons Syndrome Induced by Carbamezapene

Pattern of cutaneous adverse drug reactions in an adverse drug monitoring center at a tertiary care hospital in Kerala

Background: Pre-marketing clinical trials can filter only about 50% of the drug reaction. Hence, to prevent the morbidity and mortality due to severe cutaneous reactions early detection, evaluation and monitoring of adverse drug reaction (ADR) especially cutaneous ADR (CADR) are mandatory. Hence, it is imperative that we update our knowledge of the precise nature of ADR which will prevent the reactions as well as to find the offending drug. Aim and Objectives: The aim of the study was to evaluate the pattern of CADR, the suspected drugs and to perform the causality assessment using WHO casualty assessment scale. Materials and Methods: A retrospective descriptive study was done using the data reported to ADR monitoring center in the Department of Pharmacology by the health-care professionals. Suspected CADR was diagnosed by the consultants concerned. The CADRs collected were categorized according to their morphology into maculopapupar rash (MPR), fixed drug eruptions (FDE), urticaria, Stevens-Johnson syndrome, and toxic epidermal necrolysis. The causality assessment was done using WHO Causality assessment scale. Results: The mean age was 47.20 + 22.31. The most common CADR reported was Urticaria 65.5% followed MPR 23%, FDE 8.8%, and Steven Johnsons Syndrome 2.2%. Anti-microbial drugs were the most frequent cause of the adverse reactions with Amoxicillin clavulinic acid combination being the most frequent suspected drug producing CADR (13.3%). The WHO causality assessment for majority of CADR was Possible (73.5%). Conclusion: Clinical Patterns of CADRs in this set up have some minor variations when compared to studies done across India. Amoxicillin clavulinic acid is the most common suspected drug in this study which was not frequently reported in other ADR monitoring centers.

NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS AND STEVEN JOHNSONS SYNDROME WITH SEVERE ARDS HERALDED BY POST-COVID-19 INFECTION MULTISYSTEM INFLAMMATORY SYNDROME IN AN ADULT (MIS-A)

NEW-ONSET SYSTEMIC LUPUS ERYTHEMATOSUS AND STEVEN JOHNSONS SYNDROME WITH SEVERE ARDS HERALDED BY POST-COVID-19 INFECTION MULTISYSTEM INFLAMMATORY SYNDROME IN AN ADULT (MIS-A)

Ilae classification of seizures and antiepileptic medications apothegmatic: hereafter advancement and clinical practice

Introduction: The Antiepileptic medications are frequently categorized into divisions such as ‘first-generation’ (i.e., carbamazepine, phenobarbital, phenytoin, primidone, and valproate) and ‘second-generation’ (lamotrigine, levetiracetam, felbamate, gabapentin, topiramate, tiagabine, oxycarbazepine, zonisamide, and pregabalin). Chronic phenytoin ingestion leads to its impact in the cerebral cortex, resulting in atrophy of cerebellum, cause ataxia and nystagmus. Objective: To recapitulate the International league against epilepsy classifications, first treatment for epilepsy based on their classifications, antiepileptic medications adverse drug reaction, Methodology: The author used 74 distinctive published articles for the accomplishment of this review article. Google search engine was used for accessing published articles from databases like Google Scholar, Research Gate, PubMed, NCBI, NDSS, PMID, PMCID, Cochrane Database and CLINMED international library. Findings: Tonic-clonic is characterized by stiffness for loss of consciousness occurred by tonic extension and rhythmic clonic contractions of all considerable muscle groups. Antiepileptic drugs are implicitly an effective treatment for patient with epilepsy. Carbamazepine cause serious and sometimes fatal dermatologic reactions, including toxic epidermal necrolysis and stevens-johnson syndrome, aplastic anemia and agranulocytosis, Suicidal Behavior and Ideation, Stevens johnson syndrome, cholestatic jaundice, ataxia, xerostomia, speech disturbances, feeling sleepy Conclusion: Commonly happening side-effects of AEDs are memory troubles, exhaustion, tremors, gastrointestinal symptoms, osteoporosis, depression, drowsiness, dizziness, weight change, nausea. In generalized seizures, on the other hand, the seizure is generalized from the endeavor (i.e., primary generalized seizures), launching in both hemispheres of the brain contemporaneously

554 Preventing accidental central line removal: Early success through a novel securement device

IntroductionCentral Venous Catheter (CVC) placement and maintenance can be difficult due to non-intact skin and possible surrounding weeping wounds. In addition, routinely used products require intact skin for the adherence of the central line dressing along with sutures or securement devices. With the increased number of line dislodgements, the Burn Intensive Care Unit (BICU) searched for alternative means of line securement. A subcutaneously anchored sutureless system (SASS) was found that could secure the line and allow for improved cleaning around the insertion site. The SASS is a device made of metal which resides in subcutaneous portion of the skin and anchors the CVC while allowing lifting of the catheter to clean underneath.MethodsAfter identification of the SASS product, a trial was implemented. Nurses (RN) and providers were trained virtually by the product representative. Nursing champions were selected to be a liaison between the product representative and the staff. Patients included burn patients or Steven Johnsons (SJS) patients, with large open total body surface area, who had a CVC placed peripherally or centrally between September 2020 to June 2021. A survey was conducted upon insertion of the device, with dressing changes, and upon removal.ResultsIn 2018, there were a total of 14 CVC dislodgements and 12 in the year 2019. For the year 2020, there were 4 dislodgements and 2 in 2021. Both adult and pediatric patients utilized approximately 12 SASS. From the nurses who cared for the patients, 19 responses were obtained regarding the SASS. Overall, 94% of staff recommended this product for use. No accidental removal of the CVC was reported with use of the SASS. With cleaning around the catheter insertion site, 53% believed that they were able to clean better while 47% felt that it was the same with the previous practice. In terms of duration of changing the dressing and maintaining the catheter, 53% felt that it was the same while 47% thought it was faster. During maintenance, the most discomfort reported by patients was 4/10.ConclusionsThe SASS can be implemented as another viable method to prevent accidental dislodgement of the CVC while securing CVC without sutures. In addition, RNs believed it allows for faster cleaning around the insertion site and faster dressing changes with minimal discomfort to the patient. More data can be collected over longer periods of time and to look at its efficacy in non-burn patients.

Oxcarbazepine-induced stevens johnson syndrome and toxic epidermal necrolysis overlap

Oxcarbazepine-induced stevens johnson syndrome and toxic epidermal necrolysis overlap

A Case Report of Steven Johnson Syndrome

Introduction: In 1922, two doctors, Albert Mason Stevens and Frank Johnson, examined purulent conjunctivitis.”
 Background: Stevens-Johnson syndrome was named after them as a result of their study. The incidence rate is 7 cases per million populations per year.
 Case Presentation: Master Yash Ghudam was brought to AVBRH by his parents with chief complaints of fever since 5 days and erythematous lesions all over body since 3 days.
 History of present illness: Patient was apparently alright 5 days back, and then he started having fever which was of high grade and was not associated with chills and rigor. Patient was treated on OPD basis and the symptoms of an unexplained disease in two young boys, aged 7 and 8, who had "an unusual, generalised eruption of continued fever, inflamed buccal mucosa, and extreme some antibiotic was given, but there was no relief, after 2 days there was ulcers formation inside the mouth for which some ointment and syrup becosule was started. But lesions were increasing. 3 days back the lesions first appeared on chest then got spread to legs and hands. For which patient was admitted in Chandrapur hospital from were the patient was referred to AVBRH for further management. 
 Interventions: The patient was treated the patient was started on intravenous and orally Cortecosteroids, Omnacortil 10mg, Antibiotics- Inj. Ceftriaxone1gm IV 12 hourly [100mg/kg/day], inj. Amikacin 150mg IV 12 hourly [15mg/kg/day], Syp. Mucaine gel 2tsp BD – swish and swallow), Syp. Cital 2.5ml TDS, Tab. Chymoral Forte TDS, Inj. Pantop 20mg IV 24 hourly (1mg/kg/dose).
 Pandya’s Formula: Syp. Gelusil 5ml, Syp. Benadryl 5ml, Syp. Omnacortil 5ml. Skin allograft: It has been planned.
 Conclusion: In this study, we mainly focus on medical management and outstanding nursing care helped prevent farther complication. Overall, the patient's reaction was positive, though recovery time from Steven johnson syndrome varies from person to person, taking weeks, months, or even years. However, only a small number of people completely recover, while some have long-term consequences. She took a long time to get back on her feet.

Understanding Immune Responses to Surgical Transplant Procedures in Stevens Johnsons Syndrome Patients.

Stevens Johnsons syndrome (SJS) is a mucocutaneous disorder caused by an autoimmune response most commonly to medications. Unless it is properly managed in the acute setting, this entity can affect the ocular surface causing chronic cicatrizing conjunctivitis with limbal stem cell deficiency and lid anomalies which ultimately result in corneal opacities that may limit patients' visual acuity. When this stage is reached, some patients might need to undergo some form of corneal and/or limbal stem cell transplantation that exposes an already sensitized immune system to a new alloantigen. While the innate immunity plays a role in corneal graft survival, adaptive immune responses play a major part in corneal graft rejection and failure, namely through CD4+ T cell lymphocytes. Hence, the management of the immune response to surgical transplant procedures in SJS patients, involves a dual approach that modulates the inflammatory response to a new alloantigen in the context of an autoimmune sensitized patient. This review will explore and discuss current perspectives and future directions in the field of ocular immunology on how to manage SJS immune responses to ocular surgical procedures, reviewing systemic and local immunosuppressive therapies and protocols to adequately manage this debilitating condition.

Pharmacogenomics and Adverse Drug Reactions: Carbamazepine Induced Steven Johnsons Syndrome

Pharmacogenomics and Adverse Drug Reactions: Carbamazepine Induced Steven Johnsons Syndrome

Amoxycillin-clavulanic Acid Induced Stevens Johnson Syndrome: A Pediatric Case Report

Stevens Johnson Syndrome is an unlikely, lethal, severe skin and mucosal hypersensitive reaction of delayed type, identified by detachment of epidermis, necrosis of mucosa with stomatitis and purulent conjunctivitis requiring prompt medical intervention. Drugs like antibiotics, anticonvulsants and oxide inhibitors are the vital cause of developing Stevens Johnson syndrome. A 12 year old female patient was admitted in pediatric department with the chief complaints of oral lesions on the bilateral buccal mucosa and hard palate causing difficulty in opening mouth and swallowing since 10 days. Past medical history revealed that the patient had fever and sore throat and was prescribed tablet amoxyclav (amoxicillin – clavulanic acid) by a local medical practitioner, after that patient developed ulcer in the buccal cavity and around the lips. The patient was managed with cephalosporin antibiotic (ceftriaxone), betadine mouthwash, candid ointment, nutritional supplements and systemic steroids (dexamethasone). Naranjo causality assessment score was 6 in our patient and amoxicillin clavulanic acid induced Stevens Johnson syndrome was probable and moreover on severity assessment by Hartwigs Severity Assessment Scale the severity level for the suspected adverse drug reactions was 5 therefore amoxicillin clavulanic acid induced Stevens johnson syndrome was a severe adverse drug reaction. Early detection of symptoms of Stevens johnson syndrome followed by prompt withdrawal of offending drug and timely management can improve the clinical condition of patients. Key words: Amoxicillin - clavulanic acid, Hartwigs Severity Assesment Scale, Stevens Johnson Syndrome, Hypersensitivity reaction, Naranjo Causality Assessment.

Dermatological patients in the Intensive Care Unit – a hospital record based retrospective study

Background: Various dermatological conditions can be life threatening and may require admission in the intensive care unit for monitoring and management. We carried out this study to assess the profile of dermatological admissions in the intensive care unit. Materials and Methods: It was a cross sectional retrospective study in which the records of all patients of various dermatological disorders admitted in the intensive care unit over a period of three years was studied and the clinical details were assessed. Results: Over a period of three years, a total of 16 patients (M:F 10:6), aged between 16-71 years (mean 46±2.31 years) were admitted with an underlying dermatological disorder. The most common condition requiring admission was Stevens Johnsons Syndrome (n=5), followed by Pemphigus vulgaris (n=4), erythroderma(n=2), pustular psoriasis, dermatomyositis, necrotizing faciitis, dapsone hypersensitivity syndrome and cutaneous lymphoma in 1 each. Interventions like mechanical ventilation were required in 2 patients, inotropic support in 2 patients, central venous line placement, renal replacement therapy and tracheostomy in one patient each. The mean duration of ICU stay was 14.2 days and mortality was the outcome in 2 patients of pemphigus vulgaris which was attributed to septicemia and shock. Conclusions: Dermatological disorders can cause significant morbidity and may require proper care in the intensive care unit. Timely initiation of intensive care can help in reducing the morbidity and preventing mortality.

Sulfadiazine induced Stevens Johnson syndrome in toxoplasmosis patient: a case report

Stevens johnson syndrome is an acute, self-limited disease, presenting as severe mucosal erosions with widespread erythematous, cutaneous macules or atypical targets. Even though sulfadiazine has been mainly associated with haematological-related adverse effects, sulfadiazine induced skin necrosis has received less attention or went unrecognized. Here is a 29-year- old Indian male received T. Sulfadiazine 500mg 1-1-1-1 and experienced a severe skin reaction which was diagnosed as stevens johnson syndrome (SJS). The above drug will be implicated in cases of stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). There are few case reports of that have been associated with stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). We hope that this case report creates awareness to the health care professionals. Clinicians must be aware of these adverse reactions and advise their patients to contact them as soon as they observe any unexpected clinical response. Early diagnosis helps the clinician to elude secondary infection and subsequent complications. The offending drug should be discontinued and never be rechallenged.

Nutritional management in stevens johnson syndrome

IJNMHS - J Nutr Metab Health Sci- Print ISSN No:-2582-6301 Online ISSN No:-2582-628X,IP Journal of Nutrition, Metabolism and Health Science (JNMHS) open access, peer-reviewed quarterly journal publishing since 2018 and is published under the Khyati Education and Research Foundation (KERF), is registered as a non-

574 Assessment of the Relationship Between Mental Illness and Inpatient Length of Stay

Abstract Introduction Mental illness and burn injury requiring hospitalization are uniquely intertwined. While literature has shown that burn patients are more likely to experience acute stress disorder, post-traumatic stress disorder, and depression, the impact of pre-existing mental illness on the duration of inpatient hospitalization for burn patients is unclear. We aim to assess the impact of acute mental illness requiring treatment by a psychiatrist during admission to a burn unit on patient length of stay (LOS). Methods A retrospective analysis was conducted using burn registry data to evaluate patients age 18 to 65 admitted between January 1, 2017 and December 31, 2018. Patients admitted with burns, inhalation injury, frostbite and Steven Johnsons Syndrome were included. Patient age, total body surface area (TBSA), LOS, and psychiatry consult (PC) incidences were collected. Patients were separated into psychiatric (P) and non-psychiatric (NP) groups to compare the impact of PC on LOS. Multiple linear regression analysis was conducted in both groups to evaluate the impact of TBSA and age on LOS. Two-sample t-test assuming unequal variances was conducted to compare age, TBSA, and LOS in both groups. Results Multiple regression in the P (n=71) group indicated both age and TBSA explained 48.4% of the variance of LOS (R²= 0.48, F(2,68)= 31.96, p< 0.005). TBSA significantly predicted LOS (β= 275.9, p< 0.005), but age was insignificant (β= 0.177, p=0.4). Multiple Regression in the NP (n=617) group found that both age and TBSA explained 11% of the variance of LOS (R²= 0.11, F(2,613)=39.9, p< .005). TBSA and age significantly predicted LOS (β = 59.9, p< .005), (β = 0.09, p= 0.05), respectively. T-test assuming unequal variance found there was no significant difference in age for NP group (m= 41.73, SD= 14.02) and P group (m= 43.77, SD= 13.53; t(87)= 1.98, p = 0.11). TBSA held no significant difference between both P (m=0.05, SD= 0.08) and NP (m=0.05, SD= 0.09; t(93)= 1.98, p= 0.94). However, LOS was significantly different for P (m=26.20, SD= ±32.92) than NP (m=9.58, SD= ±17.57; t(75)= 1.99, p < 0.005) Conclusions It is an expected finding that TBSA had a significant impact on LOS, and age did not. Since the TBSA and age between N and NP are not significantly different, the impact of this correlation cannot account for the difference between LOS in the two groups. The correlation between PC and increased LOS may be used to more effectively estimate duration of inpatient admission for burn patients with psychiatric illness. Applicability of Research to Practice Directly applicable to practice.

Fuchsrsquo; syndrome in an adult male: A new case report

Fuchs’ syndrome or Stevens-Johnson syndrome without skin involvement is an uncommon disease. It is manifested by the involvement of at least two mucous membranes. Atypical stevens johnson syndrome is often associated with mycoplasma pneumonia infection. The association with a herpes virus infection is exceptional. We describe a case of a young patient who consulted for oral and genital erosions and in whom the diagnosis of fuch's syndrome was retained on clinical and paraclinical arguments

Systemic lupus erythematosus presenting as stevens johnson syndrome in a thirty years old female: a case report

Background: SJS occurs almost exclusively secondary to drugs but very rarely, SLE can be an inciting factor for SJS without presence of an offending drug. The association is extremely rare, however few cases have been reported. Case presentation: We present a case report of a thirty year old female who presented to the rheumatology clinic with complaints of rash on her face, swelling of the lips and oral ulcers with severe hemorrhagic cheilitis. She also complained of persistent high grade fever with development of blisters on her face and oropharyngeal mucosa. She had been suffering from pain in multiple joints which did not respond to NSAIDs. A diagnosis of SLE presenting as SJS was established. Patient was given good supportive care, steroids, DMARDs and analgesics, to which she responded well and recovered. Conclusion: Stevens Johnson Syndrome is an uncommon, severe dermatological condition usually caused secondary to drugs. Secondary cause of the disease may rarely be co-existence of an autoimmune condition like SLE, as present in our patient.

Drug induced Stevens Johnsons Syndrome : a case report

Stevens Johnson syndrome is an acute self limited disease presenting with severe mucosal erosions with widespread erythematous, cutaneous macules or atypical targets .The majority of cases are drug induced affecting oral and perioral region.
 A 3 year old male child presented with chief complaints of fever, cough, cold , breathlessness and extensive rashes on the skin of face , oral mucosa, neck, abdomen, erythema of conjunctiva , ulceration of eyelid and oral cavity. The reaction was evoked after consumption of tab oxcarbamezapine since 10 days . He was treated with corticosteroids , antimicrobial drugs and oral topical anesthetic agents. Health care providers must be careful regarding the adverse effects of drugs especially the allergic manifestations like anaphylaxis and Steven Johnson syndrome which are potentially fatal conditions. The most commonly and widely prescribed drug regimens should also be used judiciously and continuously monitored to prevent such a fatal adverse drug reaction.

Severe Drug-Induced Linear IgA Bullous Dermatosis: Not Everything is Steven Johnsons Syndrome

Severe Drug-Induced Linear IgA Bullous Dermatosis: Not Everything is Steven Johnsons Syndrome