88.Steven Jhonson Syndrome(SJS)

Clinical Features:

1)Flue like upper respiratory illness followed by 

2)Erythematous macule → Central necrosis→ vesicle→ bullae→Area of denudation

3)Site: Face, trunk and extremities

4)Rapidly spread within 4 days

5)Plus two or more mucosal surface involvement such as eye,

oral cavity, upper airway,oesophagus,GIT,urogenital orifice

6)Burning sensation+edema+Erythema followed by Bullae,

ulceration,hemorrhagic crusting on oral orifice.

7)Difficulty with swallowing

8)Rectal erosion

9)Painful urination

10)cough

11)Skin tenderness minimal

12)New lesions occurs in crop

13)Complete healing takes 4-6 weeks

14)Eye lesions may be results in

• Photophobia 
• Corneal ulceration.
• Keratoconjunctivitis
• Panopthalmitis
• Even blindness

15)Genital lesions: Urethritis, vaginal ulcer.

D/D: 

• Bollus SLE 
• Toxic Epidermal necrolysis 

SJS RX

🗒️Rx:(Hospital) 

🖍Diet:NPO 

✔Wash all body with normal saline

✔Wash all orifice with normal saline 

✔Maintain intake-output chart

1.Inf.Hartman ([post id="506" title="Hartmann"])(1L) +

Inf.5%DNS([post id="510" title="DNS"])(1L) +

Inf.5%DA ([post id="511" title="Dextrose "])(1L) ….I/V 30 drop/min.

2.Inj.Ceftron([post id="398" title="Ceftriaxone"])  (1gm) … 1 vial I/V ….BD 

3.inj.Amikacin([post id="411" title="Amikacin"])(500mg/2ml)-BD

4. Inj.Sergel ([post id="392" title="Esomeprazole"])((40mg) …1 vial I/V ….BD

5.Inj.Avil ..1 amp i/m stat ([post id="706" title="Pheniramine"])

6.Inj.oradexon([post id="472" title="Dexamethasone"])

1ampl I/V stat& tds if no response then given methylprednisone

Inj.Solupred([post id="705" title="Methylprednisolone"]) (500 mg/8ml)(1-2mg/kg/day-BD)-3-5DAYS (22unit + 10 ml N/S)

7.Micoral gel ([post id="468" title="Miconazole"]) -apply inside oral cavity-6 hrly

8. Cream Fusitop HC([post id="548" title="Fusidic+Hydrocortisone"]) -apply whole body-BD

9.Inj.Ascosone ([post id="466" title="Ascorbic Acid"]) (1/2 amp )+ B50 forte (1/2 amp) + 10 ml IVF, I/V –OD

Must notice this :

✔Oint.Vascline Apply in all orifices

✔Viodin mouth ([post id="467" title="Povidone-Iodine"])wash wash mouth 8 hoursly

✔Trialon ([post id="606" title="Triamcinolone"]) Oral Paste Apply locally INSIDE mouth- 12 hrsly

✔Mupiderm ([post id="524" title="Mupirocin"])Ointment Apply locally (whole body),12 hrsly (2pm and 10 pm)

🤷‍♀️if viral infection suspected-

✔Virux HC ([post id="612" title="Acyclovir"]) Apply locally (whole body),12 hrsly (2pm and 10 pm)

🤷‍♀️if Eye involve-

✔Gauze shocked with eye -2 hrly

✔Iventi eye([post id="415" title="Moxifloxacin"])drop 1 drops,4 times in both eyes.

✔Refresh tear’s eye([post id="704" title="Carboxymethylcellulose-Sodium"]) .....1 drop  .....2 hrly -8 times/day

✔Hypomer ([post id="703" title="Hypromellose+Carbomer"]) gel 1 drops 4 times in both eyes 

🤷‍♀️if pain:

Tab.Rolac(10mg)c([post id="450" title="Ketorolac"])

১+০+১....৩ দিন

🤷‍♀️if itching:

Syup. Xyril ([post id="534" title="Hydroxyzine"]) ....1+0+1....10 DAYS

OR

💊Tab.Rupa(10mg)([post id="542" title="Rupatadine"])

০+০+১.....১০ দিন।

💉IVIg given if available