Stevens-Johnson syndrome and toxic epidermal necrolysis

Revision as of 21:47, 30 April 2012 by Moomoodoctor (talk | contribs) (Disposition)

Background

  • SJS and TEN involve immune-complex mediated cell death w/ separation of epidermis from dermis
    • SJS involves <10% of BSA
    • TEN involves >30% of BSA

Diagnosis

  • Often have prodrome (fever, URI symptoms, HA, malaise)
  • Rash begins suddenly
    • Target lesions
  • Mucous membranes can be severely affected
    • Eye involvement can be severe
  • In severe cases, respiratory tract and GI involvement may occur

Work-Up

  • CBC
  • Chem
  • ESR
  • CXR

Treatment

  • Removal of inciting cause if identified
  • Treat shock w/ IV fluids according to burn protocols

Disposition

  • Admit to burn unit or ICU

Prognosis (validated) with SCORTEN mortality assessment:

One point for each of the following assessed within 1st 24 hours of admission:

  • Age >/= 40 years (OR 2.7)
  • Heart Rate >/= 120 beats per minute (OR 2.7)
  • Cancer/Hematologic malignancy (OR 4.4)
  • Body surface area on day 1  >10% (OR2.9)
  • Serum urea level (BUN) >28mg/dL (>10mmol/L) (OR 2.5)
  • Serum bicarbonate <20mmol/L (OR 4.3)
  • Serum glucose > 252mg/dL (>14mmol/L) (OR5.3)


Predicted mortality bsed on above total:

Score 0-1 (3.2%)

2  (12.1%)

3  (35.3%)

4  (58.3%)

5+  (90.0%)

Source

Tintinalli