DOI: 10.36347/sjmcr.2016.v04i09.014

Pages: 675-677

Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are both acute life-threatening rare dermatoses that are characterized by extensive epidermal sloughing at the dermoepidermal junction resulting from keratinocyte apoptosis. We herein report a case in which a complication of SJS occurred during treatment for methicillin resistant Staphylococcus aureus (MRSA) infection. A seventy-four-year-old male patient presented with fever, along with pain and swelling at the site of an implantable defibrillator. An infusion of vancomycin and amikacin was initiated, and the removal of the defibrillator was executed at a local medical facility. The patient’s blood and wound cultures were positive for methicillin resistant Staphylococcus aureus. On the 8th day of hospitalization, the patient had fever and multiple erythema multiforme lesions were found on his body. Fur appeared in his oral cavity, both palms and scrotum and the fur changed into mucous membrane lesions, suggesting SJS. On the 11th day of hospitalization, his systolic blood pressure decreased, his respiratory function deteriorated, and his condition was complicated by thrombocytopenia and coagulopathy so that he was transported to our hospital. All of the medications that had been used were ceased. The patient received an infusion of methylprednisolone and immune-globulin. The patient underwent mechanical ventilation under tracheal intubation to allow for a massive infusion, a transfusion of platelets and fresh frozen plasma. After these treatments, the patient’s vital signs, inflammatory markers, thrombocytopenia and coagulopathy improved. He was thereafter able to eat and was transferred to the dermatology ward on the 18th day of hospitalization. To obtain a favorable outcome in SJS/TEN, the timely recognition of the disease, the early cessation of the causative drug, and the immediate provision of critical intensive care are essential.