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Review
. 2020 Apr 28:11:2040622319894469.
doi: 10.1177/2040622319894469. eCollection 2020.

Multidisciplinary care in Stevens-Johnson syndrome

Swapna S Shanbhag  1 , James Chodosh  1 , Cherie Fathy  2 , Jeremy Goverman  3 , Caroline Mitchell  4 , Hajirah N Saeed  5
Affiliations
Review

Multidisciplinary care in Stevens-Johnson syndrome

Swapna S Shanbhag et al. Ther Adv Chronic Dis. .

Abstract

Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are potentially fatal mucocutaneous diseases that can involve many organ systems. Manifestations of SJS/TEN outside of the skin, eyes, and oral mucosa are not well defined or well recognized, and, therefore, are often not addressed clinically. As supportive care improves and mortality from SJS/TEN decreases, chronic complications in affected organ systems are becoming more prevalent. Recognition of the manifestations of SJS/TEN in the acute phase is critical to optimal care. In this review, we review the organ systems that may be involved in SJS/TEN, provide an overview of their management, and propose a list of items that should be communicated to the patient and family upon discharge. The organ systems discussed include the pulmonary, gastrointestinal/hepatic, oral, otorhinolaryngologic, gynecologic, genitourinary, and renal systems. In addition, the significant psychosocial, nutritional, and pain consequences and management of SJS/TEN are discussed.

Keywords: Stevens-Johnson syndrome; burns; complications; gastrointestinal; gynecologic; ocular; pulmonary; toxic epidermal necrolysis.

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Conflict of interest statement

Conflict of interest statement: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Skin and ocular complications of SJS/TEN in the acute and chronic phases. (a) Acute SJS/TEN with maculopapular rash of skin. (b) Mucositis of the oral mucosa can also be seen. (c) Fluorescein dye illuminated with cobalt blue light showing lower eyelid margin skin sloughing and conjunctival (arrow) and corneal (arrowhead) epithelial defect in the acute phase. (d) Hypertrophic facial scarring in the chronic phase. (e) Corneal neovascularization in the chronic phase (a scleral contact lens can be also be seen in the image). (Informed consent has been obtained for publication of images). SJS/TEN, Stevens-Johnson syndrome/toxic epidermal necrolysis.
Figure 2.
Figure 2.
Pulmonary complications in acute SJS/TEN. Axial views of computed tomography chest scan showing (a) patchy consolidation in the lung bases bilaterally with bilateral pleural effusions, and (b) ground-glass opacities. SJS/TEN, Stevens-Johnson syndrome/toxic epidermal necrolysis.
Figure 3.
Figure 3.
Renal complications in acute SJS/TEN. Coronal view of computed tomography scan of the abdomen of an SJS/TEN patient with acute renal failure showing (a) wedge-shaped cortical perfusion defect in the right and left kidney (highlighted by red circles), and (b) wedge-shaped cortical perfusion defect in the left kidney (highlighted by a red circle). SJS/TEN, Stevens-Johnson syndrome/toxic epidermal necrolysis.
Figure 4.
Figure 4.
Gastro-intestinal complication in acute SJS/TEN. Barium swallow demonstrating two areas of luminal narrowing and mucosal irregularity in the thoracic esophagus, suggestive of esophageal strictures (highlighted by white arrows). The first stricture is at the level of the aortic arch (3–4 cm long, approximately 67% narrowed), and the second stricture is at the level of the pulmonary artery (1 cm long, approximately 50% narrowed). SJS/TEN, Stevens-Johnson syndrome/toxic epidermal necrolysis.
See this image and copyright information in PMC

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