Case series


Stevens-Johnson syndrome/toxic epidermal necrolysis management in the burn intensive care unit: A case series

Jasmin Rahesh MS, MBA, Layan Al-Sukhni, John A. Griswold MD

ABSTRACT

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) comprise a spectrum of severe hypersensitivity skin reactions. Stevens-Johnson syndrome is the least severe on the spectrum of mucosal erosions, and TEN is the most severe. Stevens-Johnson syndrome/toxic epidermal necrolysis is a disease of keratinocytes, and therefore any squamous cell epithelium is at risk. This includes the cornea, conjunctiva, oral mucosa, esophagus, urethra, and anal canal. This skin reaction is typically drug-induced and has a very poor prognosis.

Methods: We present four different SJS/TEN patients who were managed solely in the burn intensive care unit (ICU) at our facility. Treatment focused on supportive care with an emphasis on fluid and electrolyte replacement.

Results: The age of these patients ranged from 28 years old to 73 years old; three patients were men, and one patient was a woman. The total body surface area involved ranged from 50% to 90%. These patients required 5 to 18 days hospitalization; complications included one case of sepsis and one case of disseminated herpes simplex virus. Two patients died.

Conclusion: The cases reported in this series illustrate the types and complexity of SJS/TEN patients managed in our burn ICU. The management of these patients in the burn ICU with a comprehensive interdisciplinary wound care team may improve outcomes.

Keywords: Stevens-Johnson syndrome, toxic epidermal necrolysis, burn unit ICU




Article citation: Rahesh J, Al-Sukhni L, Griswold JA. Stevens-Johnson syndrome/toxic epidermal necrolysis management in the burn intensive care unit: A case series. The Southwest Respiratory and Critical Care Chronicles 2022;10(44):40–44

From: Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, Texas

Submitted: 3/21/2022

Accepted: 6/29/2022

Conflicts of interest: none

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