Stevens- Johnson syndrome: case presentation

Erythema Multiforme (EM) is a rare mucocutaneous disease with a variety of clinical manifestations. EM it was recognized in the early 1800’s, and still the etiology is unknown. It has been recently sug-gested erythema multiforme (EM) major and Stevens-Johnson Syndrome (SJS) could be separated as two distinct clinical disorders with similar mucosal erosions, but different patterns of cutaneous lesions. In particular SJS should be used for a syndrome characterized by mucous membrane erosions and widespread small blisters that appear on erythematous or purpuric maculae, which are different from classic targets. In SJS mouth, eyes, skin, genitalia and occasionally the esophagus and respiratory track may be affected. Oral lesions may cause severe pain and usually lips may become encrusted. Concerning ocular involvement, if there is conjunctivitis or uveitis this may lead to scarring and blind-ness. Also, the course of disease and the prognosis are in most cases severe.

1. Assier H, Bastuji-Garin S, Revuz J, Roujeau JC. Erythema mul-tiforme with mucous membrane involvement and Stevens-John-son Syndrome are clinically different disorders with distinct causes. Arch Dermatol 131: 539-543, 1995.

2. In Wood NK, Goaz PW. Differential diagnosis of oral and max-illofacial lesions. 5th edition Mosby Co., pp 78-80, 570-571.

3. In Regezi JA, Sciubba J. Oral pathology clinical pathologic cor-relations. 2nd edition Saunders W.B. pp 61-65.

4. Farthing PM, Maragou P, Coates M, Tatnall F, Leigh IM, Williams DM. Characteristics of the oral lesions in patients with cutaneous recurrent erythema multiforme. J Oral Pathol Med 24: 9-13, 1995.

5. Dohlaman CH, Terada. Keratoprosthesis in Pempigoid and Stevens-Johnson Syndrome. Adventure Experience Medicine Biology 438: 1021-1025, 1998.

6. Nesbit SP, Gobetti JP. Multiple recurrence of oral erythema mul-tiforme after secondary herpes simplex: report of case and review literature. JADA 112: 348-352, 1986.

7. Lozada F, Silverman S. Erythema multiforme. Oral Med 46: 628-636, 1978.

8. Schofield JK, Tatnall FM, Leigh IM. Recurrent erythema multi-forme: clinical features and treatment in a large series of patients. Br J Dermatology 128: 542-545, 1993.

9. Roholt NS, Lapiere J, Traczyk T, Chan LS, Woodley DT. A non-scarring sublamina densa drug eruption. J Am Acad Dermatol-ogy 32: 367-371, 1995.

10. Bastuji GS, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome and erythema multiforme. Arch Der-matol 129: 92-96, 1993.

11. Rasmussen JE. Erythema Multiforme. Should anyone care about the standards of care? Arch Dermatol 131: 726-729, 1995.

12. Nicolatou-Galiti O, Angelopoulou E, Fisfis M, Pantelidaki A. Chronic oral erythema multiforme. Archives Hellenic Medicine 14: 67-70, 1997.

13. Togliatto M. Erythema multiforme. A hetrogeneous pathologic phenotype. Minerva Stomatologica 48: 217-226, 1999.

14. Angelopoulos A, Papanikolaou S, Angelopoulou E. Oral and maxillofacial pathology 3ed edition Litsas Publications, Athens pp. 674-676, 2000.

15. Eversole LR. Immunopathology of oral mucosal ulcerative, desquamative and bullous diseases. Selective review of the liter-ature. Oral Surg Med Pathol 77: 555-571, 1994.

16. Schofield JK, Tantall FM, McCloskey D, Navarrete C, Leigh IM. Recurrent erythema multiforme: tissue typing in a large series of patients. Br J Dermatology 131: 532-535, 1994.

17. Lorazada-Nur F, Gorsky M, Sol Silverman Jr. Oral erythema multiforme: clinical observations and treatment of 95 patients. Oral Surg Med Pathol 67: 36-40, 1989.

18. Huff JC, Weston WL. Reccurent erythema multiforme. Medicine 66: 133-140, 1989.

19. Park J, Matsui D, Reider MJ. Multiple antibiotic sensitivity syn-drome in children. Canadian J Clin Pharm 7: 38-41, 2000.

20. Kokuba H, Imafuku S, Burnett JW, Aurelian L. Longitudinal study of a patient with herpes simplex virus associated erythema multiforme: viral gene expression and T-cell repertoire usage. Dermatology 198: 233-242, 1999.

21. Hata M, Tokura Y, Takigawa M. Erythema multiforme-like erup-tion associated with contact dermatitis to cutting oil. European J Dermatology 11: 247-248, 2001.

22. Hebert AA, Raiston JP. Cutaneous reactions to anticonvulsant medications. J Clinical Psychiatry 62: 22-26, 2001.

23. Pavlovic MD, Karadaglic LO, Mijuskovic ZP. Persistant ery-thema multiforme: a report of three cases. J European Academy Dermatology Venerology 15: 54-58, 2001.

24. Weston WL, Morelli JG.Target lesions on the lips: childhood her-pes simplex associated with erythema multiforme mimics Stevens-Johnson syndrome. J American Academy Dermatology 37: 848-850, 1997.

25. Kukuba H, Aurelian L, Burnett J. Herpes simplex virus associ-ated erythema multiforme (HAEM) is mechanistically distinct from drug-induced erythema multiforme: interferone is expressed in HAEM lesions and tumor necrosis factor-0 in drug-induced erythema multiforme. J Investigative Dermatology Sym-posium Proceedings 113: 808-815, 1999.

26. Villiger RM, Von Vigier RO, Ramelli GP, Hassink RI, Bianchetti MG, Villiger RM, Von Vigier RO, Ramelli GP, Hassink RI, Bianchetti MG. Precipitants in 42 cases of erythema multiforme. European J Pediatrics 158: 929-932, 1999.

27. Ayangco L, Sheridan PJ, Rogers RS. Erythema multiforme sec-ondary to herpes simplex infection: a case report. J Periodontol-ogy 72: 953-957, 2001.

28. Lozada-Nur F, Shillitoe E. Erythema multiforme and herpes sim-plex virus. J Dent Res 64: 930-931, 1985.

29. Buchner A, Lozada F, Sol Silverman Jr. Histopathologic spec-trum of oral erythema multiforme. Oral Surg 49: 221-228, 1980.