“Síndrome de Stevens Johnson”

Abstract

Male patient of 21 years of age, single, mestizo, student, born and resident in Latacunga, with personal pathological history of epilepsy 2 years ago in treatment with valproic acid 500 mg three times a day that a month ago was changed to Lamotrigine 100mg a time a day sleep, pathological history family grandmother with diabetes mellitus type II, allergy to penicillin. Patient who presented palpebral edema accompanied by pruritus for 4 days, added to the picture of blister vesicle lesions in buccal mucosa, conjunctival injection accompanied by secretion, lacrimation and appearance of papular erythematous lesions of small size, on face, trunk, abdomen and extremities. Vital signs PA 127/77 mm Hg, FC 102x', FR 20x', Axillary temperature 36.71 ° C. Physical examination shows bilateral eyelid edema, sclera with conjunctival injection, yellowish discharge, edematized buccal mucosa, erythematous, with blisters and lacerations on the cheek and palate, violaceous vesicles and erythematous papules isolated and disseminated on the thorax, abdomen and extremities. adds a damage of 9% of total body surface, negative Nikolsky sign. Laboratory tests are performed that report mild neutrophilia, mild transaminitis, normal kidney tests, and elevated acute phase reactants. On the basis of the clinic and the history of anticonvulsant intake, the diagnosis of Stevens Johnson Syndrome is established, which is why it enters with a prognosis according to SCORTEN of 3.2 mortality. It also presents an ocular complication that includes dry eye and conjunctival depithelization. Treatment is started based on corticosteroids, analgesia, hydration, gastric protectors, antiemetic, eye antibiotics, general measures and suspension of antiepileptic medication. After 24 hours, lesions on the buccal mucosa were seen to flake, with a good therapeutic response after 4 days of hospitalization, with almost total decrease in skin lesions on the ninth day. Patient has not presented convulsions throughout his hospital stay, valproic acid is reinitiated as antiepileptic treatment at 9 days of the hospitalization.