Stevens-Johnson Syndrome

 

 

Considerations

 

  • Severe life threatening drug reaction with high morbidity/mortality 

  • Possible difficult airway (edema & ulcerations)

  • Respiratory:

    • Hypoxia

    • Hypersecretions

    • Pulmonary edema & ARDS

    • Blebs & pneumothorax

    • Tracheobronchitis

  • Cardiovascular: 

    • Septic shock common cause of death

    • Hypovolemia, third spacing 

  • Renal: electrolyte abnormalities, renal failure 

  • Significant pain requiring multimodal analgesia 

 

 

Treatment

 

  • Transfer to ICU/burn unit 

  • Institute supportive care:

    • Fluid & electrolyte management (fluids: use parkland formula in acute phase)

    • Analgesia 

    • Nutritional support

    • Temperature management 

    • Antibiotics for superinfections 

  • Adjunctive therapies (all controversial, no good evidence):

    • Steroids if indicated 

    • IVIG

    • Cyclosporine

    • Plasmapheresis

    • Anti-TNF monoclonal antibodies