Stevens Johnson syndrome

Blood dyscrasias are quite uncommon, but if they occur may be serious enough to cause discontinuance of the therapy. Both topical and systemic adrninistration of sulfas can cause hypersensitivity reactions, such as urticaria, exfoHative dermatitis, photosensiti2ation, erythema nodosum, and in its most severe form, erythema multiformexudativum. (Stevens-Johnson syndrome). In general, however, use of sulfonamide therapy is considered relatively safe. 

The patient is at risk for Stevens-Johnson syndrome when taking the cephalosporins StevensJohnson syndrome is manifested by fever, cough, muscular aches and pains headache, and the appearance of lesions on the skin, mucous membranes and eyes The lesions appear as red wheals or blisters often starting on the face, in the mouth, or on the lips neck, and extremities This syndrome, which also may occur with the administration of other types of drugs can be fatal. The nurse should report any of these symptoms to the primary health care provider immediately. 

Pemphigus, bullous dermatitis herpetiformis, severe erythema multiforme (Stevens-Johnson syndrome), exfoliative dermatitis, mycosis fungoides, severe psoriasis, severe seborrheic dermatitis, angioedema, urticaria, various skin disorders, such as lichen planus or keloids... 

Stevens-Johnson syndrome fever, cough, muscular aches and pains, headache, and lesions of the skin, mucous membranes, and eyes. The lesions appear as red wheals or blisters, often starting on die face, in the mo util, or on the lips, neck, and extremities, stomatitis inflammation of die mo util striae lines or bands elevated above or depressed below surrounding tissue, or differing in color or texture subjective data information supplied by the patient or family sublingual under die tongue... 

Dyspnea (bronchospasm, laryngeal edema) Stevens-Johnson syndrome... 

NSAIDs can induce a number of other adverse reactions, including bleeding disorders, anemia, thrombocytopenia, erythema nodosum, erythema multiforme, fixed drug eruptions, toxic epidermal necrolysis, Stevens-Johnson syndrome, leukocytocla-sitc vasculitis, recurrent fever with exanthema and, of course, the well-known gastric cytotoxicity. 

Stevens-Johnson syndrome, a severe erythema, was seen in five people occupationally exposed to trichloroethylene for 2-5 weeks at levels ranging from 19 to 164 ppm (Phoon et al. 1984). The study authors suggested that the erythema was caused by a hypersensitivity reaction to trichloroethylene. An exfoliative dermatitis (Goh and Ng 1988) and scleroderma (Czirjak et al. 1993), also thought to have an immune component, have been reported in persons occupationally exposed to trichloroethylene. 

Phoon WH, Chan MOY, Rajan VS, et al. 1984. Stevens-Johnson syndrome associated with occupational exposure to trichloroethylene. Contact Dermatitis 10 270-276. 

Erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis... 

Stevens-Johnson syndrome—a severe expression of erythema multiforme (also known as erythema multiforme major). It typically involves the skin and the mucous membranes with the potential for severe morbidity and even death. 

N-4 position and a substituted ring at the N-l position. Because of this different chemical structure, cross-allergenicity with the other sulfonamides may not occur. However, because this has not been well studied, if a patient has a reaction to a sulfonamide antibiotic, whether or not he or she will have a reaction to these other sulfonamides remains controversial. Predisposition to allergic reactions is a more likely reason than cross-reactivity between these differing molecules.14 The sulfonamide antibiotics are significant because they account for the largest percentage of antibiotic-induced toxic epidermal necrolysis and Stevens-Johnson syndrome cases.15... 

Severe life-threatening reactions not mediated by IgE, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, are absolute contraindications to testing, desensitization attempts, and readministration. 

Connective tissue disease Substance abuse Stevens-Johnson syndrome Immunocompromised Atopic dermatitis Gonococcal infection Vitamin A deficiency... 

Streptococcus gentamicin (5 mg/kg per day, dosing based on serum levels) Alternative Therapies Trimethoprim-sulfamethoxazole (TMP-SMX) 10-20 mg/kgTMP IV per day in divided doses every 6-8 hours or meropenem Standard Therapy TMP-SMX Rash, Stevens-Johnson syndrome, bone marrow suppression, nausea/vomiting, hepatotoxicity 14-21... 

TMP-SMX Nausea/vomiting Myelosuppression monitor CBC Hepatic abnormalities monitor LFTs Rash including severe reactions such as Stevens-Johnson syndrome Inhibitor of CYP2C9 evaluate for potential drug-drug interactions such as warfarin... 

Rash including Stevens-Johnson syndrome symptomatic hepatitis, including fatal hepatic necrosis... 

Mild to moderate rash diffuse maculopapular rash with or without pruritus severe rash see section on Stevens-Johnson syndrome (SJS)... 

Statistical design, 54 Stereotypes, health-provider, 276-277 Sterilization experiments, 199 Stevens-Johnson syndrome (SJS), 93 STI-571,154... 

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used to treat HIV-infected patients that causes mild to severe skin rash and even Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) in a substantial proportion (16%) of patients. Nevirapine also induces hepatotoxicity. These adverse clinical symptoms may also occur in non-HIV subjects taking the drug as postoperative prophylaxis [15]. 

Fagot, J.-P. et al., Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis, AIDS, 15, 1843, 2001. 

Increased risk of Stevens-Johnson syndrome (rash). Potential increased risk of agranulocytosis. 

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