SANDY KARTIKA P C11108214 NURUL AINI C11108785

Patients Identity
Name

: Mrs. S Gender : Female Age : 56 years old Marital Status : Married Address : Jl. Vet. Utara LR 41/39 Admission Date : 3 February 2012

History Taking
Chief complaint : rupture of blisters on the back,

chest, arms, abdomen, and lipatan paha

Happen 1 week ago, starts with appear blisters

on the left armpit and ruptured later. Shortly thereafter, the patient develops widespread bullae that are easily ruptured.
Post operation of mammae (7 days before) Medication History : Tamopen, Dexamethasone,

Pirolesicam, Fever (+) 1 day before bulla presented

Physical Examination
Anemic (-), icterus (-), cyanoses (-) Erosion covering <10% of the body surface

area, stomatitis on the lips Cor / Pulmonal : Normal Abdomen : Normal, peristaltic (+)

Current Status
General status
Composmentis
Severe Sickness Adequate nutrition Moderate Hygiene

Vital sign
Blood pressure

: Pulse rate : Respiration rate : Temperature :

110/90mmHg 80x/min 24x/min 36C

Dermato-venerology Status
Location 1 : Regio Mammae dextra, abdomen sinistra Effloresensi : Bulla Location 2 : Regio extremities superior et inferior,truncusposterior Effloresensi : Bulla, vesicle, excoriation, erosion, epidermolysis Location 3 : Regio Mammae sinistra, Effloresensi : Ulcus post op Ca mammae Location 4 : Regio oralis Effloresensi : Stomatitis, crust

Laboratory Result
Ureum Creatinin GDS SGOT SGPT Natrium Kalium Chloride

: 129 mg/dl : 1,7 mg/dl : 66 mg/dl : 67 U/l : 172 U/l : 129,50 mmol/l : 4,33 mmol/l : 102,30 mmol/l

Recommended examination
Consult diet Consult ENT Chest X-ray examination Punch biopsy Immunofluorescence microscopy

Resume
A 56 years old woman came to the hospital with complain rupture of blisters on the back, chest, arms, abdomen, and lipatan paha. Happen 1 week ago, starts with appear blisters on the left armpit and ruptured later. Shortly thereafter, the patient develops widespread bullae that are easily ruptured. Pasien mengeluh susah menelan. Nyeri pada lesi (+), gatal pada lesi (+). Post operation of mammae (7 days before). Medication History : Tamofen, Dexamethasone, Piroxicam. Fever (+) 1 day before bulla presented. Family medical history with the same complain (-).

Diagnosis
Stevens-Johnson Syndrome

Treatment
1. Dexamethasone inj. 1 amp/ 6 h./ iv
2. Gentamicin 1 amp/12 h./ iv 3. Afucid cr. 4. Compress NaCl 0.3%

PICTURES

(9-02-2012)

Fig. 1 Fig.2 Figure 1: Stomatitis and crust on the upper and lower lips Figure 2: Ulcus post op Ca mammae at the upper chest of the patient.

Fig.3

Fig.4

Figure 3 and 4: SJS with bulla, vesicle, excoriation, erosion, and epidermolysis on the armpit and arms.

Fig.5 Fig.6 Figure 5: Bulla on the whole abdomen of the patient Figure 6: Erosion, bulla, and excoration on the thigh intertrigo

STEVENS JOHNSON SYNDROME

Acute life-threatening mucocutaneous reactions characterized by extensive necrosis and detachment of the epidermis.

Idiopathic - 25%
Drug allergy 50%

- Analgesic - Antipyretic - Anticonvulsan - Traditional drug And the other are Infections

TRIAS: Skin abnormality : The initial skin lesions are characterized by erythematous, dusky red, purpuric macules, irregularly shaped, which progressively coalesce. Mucous membrane involvement : The oral cavity and the vermilion border of the lips are almost invariably affected and feature painful hemorrhagic erosions coated by grayish white pseudomembranes and crusts of the lips Extra-Cutaneous Symptoms : associated with high fever, pain, and weakness

Pathogenesis

Diagnosis
Anamnesis & history taking
Physical examination Laboratory examination
o Low serum albumin and increase in gammaglobulins;

electrolyte imbalance; acute-phase proteins increased. o Leukocytosis (+) means the causes is infection o Eosinofilia (+) means the causes is allergy

Treatment
Remove any potential offending and unnecessary

medications
Address nutrition, fluid and electrolyte balance Oral corticosteroid

Local skin care with compression to weeping or

crusted sites, bland emollients and mid-potency topical corticosteroids For secondary infection with systemic antibiotics

Prognosis
If the management is fast and adequate, the prognosis

is better. The mortality rate is 5-12%. The prognosis is not affected by the type or dose of the responsible drug or the presence of human immunodeficiency virus infection but depending on the severity of the disease and the prior general condition of the patient.