A 7-year-old boy presented with skin lesions and purulent conjunctivitis of 4 days duration. He was treated for fever and cough with paracetamol, amoxycillin and phenyl-propanolamine. On examination he was febrile (104ºF) and dehydrated. The skin lesions were purpuric macules with blister formations and were present all over the trunk. There was cervical and axillary lymphadenopathy. But there was no hepatosplenomegaly. Apart from raised CRP levels and leukocytosis there were no other hematological and biochemical abnormalities. During the course of his hospitalization, the skin lesions spread to involve the limbs and face and the lesions on the trunk became confluent (Figs. 1 and 2). Later he developed oral ulcers and photo-phobia. He was provided with good supportive care and skillful nursing care which involved correction and maintenance of hydration, oral and ocular care, regular dressing of the skin lesions.

Fig. 1. Lesions of Stevens Johnson dyndrome - frontal profile.

Fig. 2. Stevens Johnson syndrome - rear view.

Stevens Johnson syndrome (SJS) is a rare disease of unknown etiopathogenesis. How-ever Mycoplasma pneumoniae and certain drugs (antiepileptics, NSAIDS, antibiotics and anti HIV drugs) are found to be major precipitating factors. The peak incidence is in the second decade of life. It is usually preceded by prodromes such as URI or unexplained fever. The extent of skin eruption is variable and all affected children have two or more mucosal sites involved. It is to be differentiated from erythema multiforme and toxic epidermal necrolysis. It is a potentially severe illness but with adequate management, morbidity and sequelae are minimal. The treatment is essentially supportive. Prophylactic antibiotics are needed only when M. pneumoniae is suspected.

The role of steroids is controversial and better avoided when infectious etiology is suspected. Encouraging results are being published recently with intravenous immunoglobulin therapy. Affected children are to be followed up regularly for sequelae like keratitis sicca, synechae, symblepharon and skin pigmentation.

H.V. Kotturesha,
Kotturesha Hospital,
Kamala Nivasa, Achutha Rao Layout,
1st cross, Shimoga 577 201,
Karnataka, India.