Desquamation: The Daily PANCE Blueprint

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Desquamation: The Daily PANCE Blueprint

A 42-year-old female presents to the ER complaining of painful “spots” all over her body. On physical exam you note erythematous macules and vesicles scattered on less than 10% of her body, as well as conjunctival injection and cheilitis. Nikolsky sign is positive. Upon further discussion, the patient tells you she was given Bactrim last week for an infection. Which of the following is the most likely diagnosis?

A. Toxic epidermal necrolysis
B. Steven Johnson Syndrome
C. Staphylococcal scalded skin syndrome
D. Toxic shock syndrome
E. Pemphigus Vulgaris

Answer and topic summary

The answer is B. Steven Johnson Syndrome

Steven Johnson Syndrome (SJS) is an immune-mediated dermatologic reaction characterized by skin blisters and epidermal detachment. For SJS, skin involvement is defined as < 10% or can be considered SJS/TEN overlap if 10-30%. Triggers include: medications (Bactrim, steroids, AEDs, allopurinol), infections (CMV, herpes), etc. Physical exam findings include painful erythematous macules, bullae and/or vesicles, sloughing of the epidermis (looks like burns), positive Nikolsky sign, and mucosal membrane involvement (e.g., cheilitis, conjunctivitis, urethritis, etc..). Treatment is similar to treatment of burns (e..g, fluid resuscitation, wound management, antibiotics). Causative medications should be discontinued.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Dermatology ⇒ Desquamation ⇒ Stevens-Johnson syndrome

Also covered as part of the Pediatric EOR, Family Medicine EOR, and Emergency Medicine EOR topic lists

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