Case history
Case history #1
A 27-year-old man with AIDS presents with a rash that developed over the last 4 days, after being on prophylactic doses of trimethoprim/sulfamethoxazole for 19 days for a cluster of differentiation 4 count of <200 lymphocytes. He has a 20% total body surface area (TBSA) skin slough with scattered patches throughout his torso and extremities. Except for conjunctival erythema, he does not have any mucosal involvement. Following successful treatment he is discharged after a 12-day hospital stay. Approximately 2 months after discharge, he takes "antibiotics for a cold and oral thrush." He develops a fever, diffuse skin erythema, and pruritus. He presents at the hospital 4 hours after taking the medication, with a blood pressure of 80/40 mmHg, temperature of 104°F (40°C), respiratory rate of 22 breaths per minute, and a heart rate of 96 beats per minute. It is discovered that the antibiotic was trimethoprim/sulfamethoxazole.
Case history #2
A 14-year-old boy presents with a 1-day history of fever, photophobia, chills, cough, tonsillar enlargement, and chapped, bleeding lips. He has a diffuse erythematous rash including the palms and soles of his feet, in total covering 54% TBSA. Within 24 hours the rash progresses to 90% TBSA involvement and the patient requires mechanical ventilation for respiratory distress. He has a history of asthma and has been taking ibuprofen for an upper respiratory infection that developed 2 weeks previously. [Figure caption and citation for the preceding image starts]: Stevens-Johnson Syndrome: epidermal loss on soles of feetFrom the personal collection of Dr A. Kowal-Vern [Citation ends].
Other presentations
Other highly specific features would be atypical target lesions (which may be confluent), macules, palpable purpuric lesions, or positive Nikolsky sign (epidermal layer easily sloughs off when pressure is applied to the affected area). Among other presentations, the patient may have fever, malaise, ocular lesions, stomatitis, swelling of the tongue, diarrhea, vomiting, dysuria, enlarged lymph nodes, arthralgias, arthritis, bronchitis, shortness of breath, wheezing, genital lesions, hypotension, and dehydration.
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