Snapshot Stevens-Johnson Syndrome A 21-year-old gentleman comes to the emergency room with a painful rash all over his body, including some lesions in his mouth. He also describes feeling feverish. On physical exam, his skin has multiple bullae that sloughs off easily with a single rub. The rash covers > 30% of his body. A careful history reveals that he was recently put on lamotrigine for his epilepsy. The lamotrigine is stopped and patient is immediately admitted to the burn unit. Introduction Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) – two diseases on the same spectrum login to view 3 more bullets Severe, febrile blistering disease of skin and mucous membranes login to view 4 more bullets Erythema multiforme (EM) is a distinct disease from SJS/TEN according to the current consensus definition Presentation Symptoms login to view 5 more bullets Physical exam login to view 4 more bullets Evaluation Based on clinical history and symptoms Skin biopsy: mainly to distinguish staphylococcal scalded skin syndrome and TEN login to view 1 more bullet Labs: normal Differential Diagnosis Staphylococcal scalded skin syndrome Graft versus host disease Pemphigus vulgaris Erythema multiforme Treatment Discontinue causative agent Supportive care login to view 2 more bullets Treat underlying infection Prognosis, Prevention, and Complications High mortality, especially with TEN