How is steven jones syndrome transmitted? Manifestations of stevens-johnson syndrome and methods of treatment

Stevens-Johnson syndrome is a bullous lesion of the skin and mucous membranes. It has an allergic nature and is characterized by an acute manifestation.

This disease occurs against the background of a serious condition of a person. It affects the oral mucosa and urinary organs.

Also, this syndrome is called "malignant exudative erythema." As well as, allergic contact, etc. it is a bullous dermatitis and is characterized by a large number of blisters on the skin and mucous membranes.

Most often, this syndrome develops in people in the period from 20 to 40 years. Very rare in children.

Men suffer from this disease more often than women.

The reasons

The causes of the development of Steven Johnson syndrome lie in the immediate allergic reaction of the body. There are four groups of reasons that can cause the onset of such a reaction:

infections;
medicines;
malignant diseases;
unknown factors.

In children, this syndrome most often develops due to viral diseases (herpes, viral hepatitis, chickenpox, measles, etc.)

Bacterial infections and fungi (tuberculosis, gonorrhea, histoplasmosis, trichophytosis, etc.) can also provoke development.

Adults mostly suffer from this syndrome due to the use of certain medications or malignant neoplasms in the body.

Of the drugs, most often such a reaction can be caused by antibiotics, regulators of the central nervous system etc.

The most common cause of cancer is lymphoma or carcinoma.

Symptoms

With the onset of the disease, the symptoms appear very quickly and abruptly. A person notes:

general malaise;
the temperature rises to 40c;
headache;
arthralgia occurs;
muscle pain;
tachycardia.

The patient may have a sore throat, diarrhea or vomiting, cough.

In a few hours, blisters begin to swell in the throat, which, after opening, form large defects. They are covered with white-gray or yellow films and blood crusts.

Lips may also be involved in the process.

Eye damage resembles conjunctivitis, but if an infection gets in, purulent inflammation may develop. It can also lead to blepharitis, keratitis, and iris damage.

Urethritis, vulvitis or vaginitis develops on the genitals.

Numerous elements appear on the skin, which rise above the rest of the skin and have a rounded shape. Outwardly, they look like blisters. They can be up to 5 cm in diameter.

The rash continues to appear for a couple of weeks. Ulcers that remain after opening the blisters heal for a month and a half.

Due to the complications that this syndrome can cause, approximately 10% of patients die.

Diagnostics

Diagnosis of this syndrome includes a large comprehensive study, during which the patient is carefully examined, an immunological blood test is performed, a skin biopsy is taken, and a coagulogram is taken. X-rays of the lungs, ultrasound are also performed Bladder, kidneys, and biochemical analysis urine.

Treatment

Treatment for Stevens-Johnson syndrome is complex and intensive. Be sure to prescribe glucocorticoids in large doses. Since these substances can affect the mucous membranes, they are injected. The dose is reduced only after the symptoms subside and the person begins to feel better.

To purify the blood, methods of extracorporeal hemocorrection are used:

cascade plasma filtration;
membrane plasmapheresis;
hemosorption;
immunosorption.

A person is given a transfusion of plasma and protein solutions.

Be sure to provide the body with plenty of fluids and maintain daily diuresis.

Potassium and calcium preparations are also used.

Secondary infections are treated with antibiotics.

Stevens-Johnson Syndrome- This is a severe malignant form of erythema multiforme, in which blisters appear on the mucous membranes of the eyes, throat, nose, genitals and other parts of the skin.

When the mucous membrane of the eyes is damaged, pain. Eyes swollen, filled purulent secretions to the extent that it causes the eyelids to stick together, the corneas undergo fibrosis. When the mucous membrane of the mouth is affected, eating becomes difficult, opening and closing the mouth leads to severe pain, which causes salivation. Urination becomes painful and difficult.

Causes of Stevens-Johnson Syndrome.

The main cause of Stevens-Johnson syndrome is the appearance of an allergic reaction to taking antibacterial drugs and antibiotics. Recently, it has been believed that this syndrome has a hereditary mechanism in which the skin is affected, as well as blood vessels.

Symptoms of Stevens-Johnson Syndrome.

This syndrome has a very rapid development, because. is allergic reaction fast type. The manifestation begins with fever, muscle and joint pain. This state continues for no more than a day. Then the oral mucosa is affected in the form of skin defects, large blisters, clotted blood clots, a gray-white film, and cracks.

The symptoms of eyes affected by Stevens-Johnson syndrome are similar to those of conjunctivitis. The only difference is that in Stevens-Johnson syndrome, the inflammation is allergic. The disease can be more severe with bacterial damage. Small ulcers and defects may appear on the conjunctiva of the eye, which will lead to inflammation of the cornea and posterior sections (vessels, retina, etc.).

The syndrome can be localized at the site of the genital organs, manifested as vulvovaginitis (inflammation of the female genital organs), balanitis, urethritis ( inflammatory process urethra).

Skin lesions in Stevens-Johnson syndrome are multiple reddening of the skin or slightly swollen blisters. The lesions are round and purple in color. The center of the spot has a bubbly appearance that contains blood or watery fluid and a bluish tint that is slightly deepened. In diameter, the size of the foci reaches up to 3-5 centimeters.

After the opening of such bubbles, defects remain in the form of redness, covered with a crust.

Stevens-Johnson syndrome gives severe complications to the overall health of the body, for example, pneumonia, kidney failure, and diarrhea may appear. In 10% of cases, the disease with Stevens-Johnson syndrome is fatal.

Diagnosis of Stevens-Johnson syndrome.

For the diagnosis of Stevens-Johnson syndrome, a general blood test is performed, the content of leukocytes, the erythrocyte sedimentation rate are detected.

More effective biochemical examination of the blood, which reveals the content of urea, bilirubin, aminotransferase enzymes.

But most effective way diagnosis is a special examination - an immunogram, which reveals the content of T-lymphocytes in the blood and specific classes of antibodies.

To establish an unmistakable diagnosis, it is necessary to know the full picture of living conditions, medications taken, diseases, and diet.

During an external examination, it is necessary to carefully examine the external manifestations in order not to confuse Stevens-Johnson syndrome with Lyell's syndrome.

Treatment of Stevens-Johnson syndrome.

In the treatment of Stevens-Johnson syndrome, hormones of the adrenal cortex are taken until the improvement in the condition stabilizes. They are mainly taken orally, but if oral administration is not possible, hormones are administered intravenously.

Used to purify the blood special methods such as plasmapheresis and hemosorption. They are used to remove the immune complex in the form of antibodies that are associated with antigens.

During treatment, it is necessary to remove toxins from the body through the intestines by taking medications. To combat intoxication, you should drink up to 3 liters of liquid in any form.

An effective measure is intravenous transfusion of plasma and protein solution to the patient. In addition to treatment, drugs containing potassium, calcium, antiallergic drugs are prescribed. At severe forms Stevens-Johnson syndrome to reduce the risk of developing infections, antibacterial agents should be taken in combination with antifungal agents.

For external treatment, antiseptic solutions and creams are used, which include hormones of the adrenal cortex.

Variety of forms of lesions skin requires their detailed classification, which allows us to attribute the current disease to a certain type and draw up the most effective treatment regimen. After all, some of the forms have not only a very unpleasant course for the patient, but can also pose a danger to his life.

And one of these varieties is malignant exudative eczema multiforme, called Stevens-Johnson syndrome, which has characteristic symptoms with damage to the upper layer of the epidermis and mucous membranes. Its course is accompanied by an active deterioration general condition patient, pronounced ulceration of the surfaces, which may lead, in the absence of the necessary medicinal effect, serious complications for human health. In this article, we will talk about the differences between Lyell and Stevens-Johnson syndromes, whether it is possible to swim, as well as the causes and treatment of the disease.

Features of the disease

Stevens-Johnson syndrome has a very rapid development with a rapid aggravation of the characteristic symptoms, which has a sharp negative effect on the patient's health. Skin lesions are expressed in the appearance of a rash on its surface, which gradually deepens into the upper layer of the epidermis and causes the formation of clearly defined lesions. In this case, the patient feels significant soreness of the affected areas of the skin, even with a slight mechanical effect on it.

This condition can occur at almost any age, but it is most often observed in people who have reached the age of 40.
But, according to doctors, today such a pathological condition has begun to occur at a younger age, as well as among infants.
In men, Stevens-Johnson syndrome occurs with the same frequency as in women, while the symptoms of the disease are completely similar.

Like any other skin lesion, Stevens-Johnson syndrome responds faster to treatment when it is detected at its maximum. early stages. Therefore, timely treatment for examination allows you to draw up a more effective treatment regimen to prevent further aggravation. pathological condition the patient's skin.

Syndrome of Lyell and Stevens-Johnson (photo)

Classification

In medical practice, there is a division of this condition into several stages, depending on the degree of neglect of the disease.

At the initial stage lesions of the skin in Stevens-Johnson syndrome are observed, which is accompanied by a deterioration in the general condition, the appearance and loss of orientation in space. Some patients experience diarrhea, digestive disorders. Along with this, at the first stage of the development of the disease, lesions begin to appear on the skin, characterized by an increase in its sensitivity. The duration of the first stage can be from several days to 2 weeks.
At the second stage progression of Stevens-Johnson syndrome, the area of the affected skin areas increases, the hypersensitivity of the skin also increases. On the surface of the skin, a small rash first appears, then with serous contents, the patient develops thirst, and saliva production decreases. At the same time, characteristic manifestations are noted both on the surface of the skin and on the mucous membranes, mainly of the genital organs and oral cavity. In this case, the rashes have a symmetrical arrangement, and the duration of the second stage of the development of the disease is no more than 5 days.
Third stage characterized by a general weakening of the patient's body, the skin and mucous membranes with lesions hurt, it manifests itself very,. With absence medical care or its insufficiency is likely to be fatal.

This video will tell about the features and concept of Stevens-Johnson syndrome:

Causes of Stevens-Johnson Syndrome

There are a number of reasons that provoke the occurrence of Stevens-Johnson syndrome and its progression. Reasons that can cause this condition to occur include:

infectious lesions of the body, which dramatically reduce the degree of efficiency of the immune system. Most often, this cause becomes the main impetus for the onset of Stevens-Johnson syndrome in children and infants when they the immune system send off;
the use of certain drugs, one of which contains a significant amount of sulfidamines, also provokes the occurrence of Stevens-Johnson syndrome;
lesions of the body of a malignant nature, which include AIDS;
the idiopathic variant of the disease can develop as a result of psychological overstrain, nervous overload and depressive states long flow.

Also, the causes of the development of Stevens-Johnson syndrome include a combination of these causes or a combination of them.

Symptoms

The most characteristic manifestations of the activation of Stevens-Johnson syndrome include the deterioration of the skin, which occurs very quickly starting from the second stage of the current pathological process. In this case, the following symptoms are noted:

an increase in body temperature and a general weakening of the body, while in some parts of the body places with red spots are formed. The sizes of such areas can vary significantly, their localization is different. The spots may be single, then they begin to merge. The location of the spots is usually symmetrical;
after a few hours (10-12), swellings form on the surface of such spots, the upper layer of the epidermis begins to exfoliate. A bubble forms inside the spot, in which the serous fluid is grayish in color. When such a bubble is opened, an affected area remains in its place, which has increased sensitivity and soreness;
gradually, the process covers an increasing surface of the skin, in parallel, there is a significant deterioration in the patient's condition.

In case of damage to the mucous membranes, hypersensitivity, swelling of tissues and their . When opening the resulting blisters, an exudate of a serous-bloody composition is released, as a result of which there is a rapid dehydration of the patient. After opening the blisters on the skin remain larger, the skin on them has a bright red color and increased sensitivity.

When Stevens-Johnson syndrome is detected, a gradual aggravation of the current condition is noted, the skin surface changes its appearance, even with a slight mechanical impact on it, significant pain is noted with the formation of erosions that are significant in area, while bubbles do not form on the skin. Body temperature continues to be elevated.

Diagnostics

Thanks to the diagnosis at the initial stages of the development of the disease, it becomes possible to improve the patient's condition as quickly as possible. For diagnostics, methods such as a biochemical and general blood test, urinalysis, coagulogram data, as well as a biopsy of the victim's skin particles are used.

The manifestations of this condition may resemble other types of skin eczema, because it laboratory methods avoid misdiagnosis. It is required to distinguish between Stevens-Johnson syndrome and,.

Treatment

Treatment, assistance with the development of Stevens-Johnson syndrome should be carried out as soon as possible to prevent a significant aggravation of the pathological process, which allows the patient to save life.

First aid consists in replenishing the body of the victim with fluid, which he constantly loses in the process of activating pathological processes in the skin.

The video below will tell about the diagnosis and treatment of Stevens-Johnson syndrome:

Therapeutic way

Since this condition is characterized by a rapid aggravation of pathological processes in the skin, providing assistance in a therapeutic way does not have a pronounced effectiveness. The most effective is the intake of certain medications to relieve pain and eliminate the main symptoms of the disease.

As an important therapeutic agent for given state can be considered bed rest and a diet based on liquid and puree foods.

In a medical way

The most important at the stage of activation of the manifestation of Stevens-Johnson syndrome is the use of glucocorticosteroids. Also to medicines with a pronounced effect should include:

cancellation of previous medicines to eliminate the possibility of exacerbation of the current state;
infusions to prevent severe dehydration;
disinfection of the skin with the help of products that dry the affected areas;
taking antibacterial drugs;
antihistamines that relieve skin burning and itching;
disinfection of mucous membranes with ointment or hydrogen peroxide.

Efficiency in the provision of medical care determines its effectiveness and obtaining pronounced results in the treatment.

Other Methods

Surgery is not recommended for Stevens-Johnson syndrome.
Folk methods also turn out to be powerless with the active process of skin lesions.

Stevens-Johnson syndrome (photo of a child)

Disease prevention

As a preventive measure, an exception can be called bad habits, compiling a menu based on healthy food, regular check-ups with a doctor in order to identify any abnormalities and diseases.

Forecast

When starting treatment in the early stages, the survival rate is 95-98%, with more neglected - from 60 to 82%. In the absence of assistance, the patient dies in 93% of cases.

This video will tell you about Stevens-Johnson syndrome in a young girl and about the fight against such an ailment:

Stevens-Johnson syndrome is an acute bullous dermatitis of allergic etiology. The disease is based on epidermal necrolysis, which is a pathological process in which epidermal cells die and separate from the dermis. The disease is characterized by a severe course, damage to the mucous membrane of the oral cavity, urogenital tract and conjunctiva of the eyes. Blisters form on the skin and mucous membranes, which prevent patients from speaking and eating, cause severe pain and profuse salivation. Purulent conjunctivitis develops with swelling and souring of the eyelids, urethritis with painful and difficult urination.

The disease has an acute onset and rapid development. In patients, the temperature rises sharply, the throat, joints and muscles begin to hurt, the general state of health worsens, signs of intoxication and asthenization of the body appear. Large blisters have a rounded shape, bright red color, cyanotic and sunken center, serous or hemorrhagic contents. Over time, they open up and form bleeding erosions that merge with each other and turn into a large bleeding and painful wound. It cracks, covered with a grayish-whitish film or bloody crust.

Stevens-Johnson syndrome - systemic allergic disease, proceeding according to the type of erythema. Skin lesions are always accompanied by inflammation of the mucous membrane of at least two internal organs. Pathology got its official name in honor of pediatricians from America, who first described its symptoms and mechanism of development. The disease affects mainly males aged 20-40 years. The risk of pathology increases after 40 years. In very rare cases, the syndrome occurs in children under six months. The syndrome is characterized by seasonality - the peak incidence occurs in winter and early spring. People with immunodeficiency and oncopathology are most at risk of getting sick. Elderly people with serious comorbidities are difficult to tolerate this disease. Their syndrome usually proceeds with extensive skin lesions and ends unfavorably.

Most often, Stevens-Jones syndrome occurs in response to taking antimicrobials. There is a theory according to which the tendency to the disease is inherited.

Diagnosis of patients with Stevens-Johnson syndrome is a comprehensive examination, including standard methods - interviewing and examining the patient, as well as specific procedures - immunogram, allergy tests, skin biopsy, coagulogram. Auxiliary diagnostic methods are: radiography, ultrasound examination of internal organs, biochemistry of blood and urine. Timely diagnosis this extremely dangerous disease avoids unpleasant consequences and serious complications. Pathology treatment includes extracorporeal hemocorrection, glucocorticoid and antibiotic therapy. This ailment difficult to treat, especially in the later stages. Complications of the pathology are: pneumonia, diarrhea, renal dysfunction. In 10% of patients, Stevens-Johnson syndrome ends in death.

Etiology

The pathology is based on an allergic reaction of an instant type, which develops in response to the introduction of allergen substances into the body.

Factors provoking the onset of the disease:

herpes viruses, cytomegalovirus, adenovirus, human immunodeficiency virus;
pathogenic bacteria - tuberculosis and diphtheria mycobacteria, gonococci, brucella, mycoplasmas, yersinia, salmonella;
fungi - candidiasis, dermatophytosis, keratomycosis;
drugs - antibiotics, NSAIDs, neuroprotectors, sulfonamides, vitamins, local anesthetics, antiepileptic and sedative drugs, vaccines;
malignant neoplasms.

The idiopathic form is a disease with an unknown etiology.

Symptoms

The disease begins acutely, symptoms develop rapidly.

Complications of Stevens-Johnson syndrome:

hematuria,
inflammation of the lungs and small bronchioles,
intestinal inflammation,
kidney dysfunction,
urethral stricture,
narrowing of the esophagus
blindness,
toxic hepatitis,
sepsis,
cachexia.

The complications listed above cause the death of 10% of patients.

Diagnostics

Dermatologists are engaged in the diagnosis of the disease: they study the characteristic Clinical signs and examine the patient. To determine the etiological factor, it is necessary to interview the patient. When diagnosing a disease, anamnestic and allergological data, as well as the results of a clinical examination, are taken into account. A skin biopsy and subsequent histological examination will help confirm or refute the proposed diagnosis.

Measurement of pulse, pressure, body temperature, palpation of the lymph nodes and abdomen.
AT general analysis blood - signs of inflammation: anemia, leukocytosis and increase in ESR. Neutropenia is an unfavorable prognostic sign.
In the coagulogram - signs of dysfunction of the blood coagulation system.
Biochemistry of blood and urine. Special attention experts pay attention to KOS indicators.
A general urine test is taken daily until the condition stabilizes.
Immunogram - an increase in class E immunoglobulins, circulating immune complexes, a compliment.
Allergy tests.
Skin histology - necrosis of all layers of the epidermis, its detachment, slight inflammatory infiltration dermis.
According to indications, sputum and discharge of erosion are taken for bakposev.
Instrumental diagnostic methods - X-ray of the lungs, tomography of the pelvic organs and retroperitoneal space.

Stevens-Johnson syndrome is differentiated from systemic vasculitis, Lyell's syndrome, true or benign pemphigus, scalded skin syndrome. Stevens-Johnson syndrome, in contrast to developing faster, more severely affects the sensitive mucous membrane, unprotected skin and important internal organs.

Treatment

Patients with Stevens-Johnson syndrome must be hospitalized in a burn or intensive care unit for medical care. First of all, you should urgently stop taking drugs that could provoke this syndrome, especially if their use was started in the last 3-5 days. This applies to drugs that are not vital.

Treatment of pathology is aimed primarily at replenishing the lost fluid. To do this, a catheter is inserted into the cubital vein and infusion therapy is started. Colloidal and crystalloid solutions are infused intravenously. Oral rehydration is possible. With severe swelling of the mucous membrane of the larynx and shortness of breath, the patient is transferred to a ventilator. After achieving stable stabilization, the patient is sent to the hospital. There he is prescribed complex therapy and a hypoallergenic diet. It consists in eating only liquid and pureed food, drinking plenty of water.
Hypoallergenic nutrition involves the exclusion from the diet of fish, coffee, citrus fruits, chocolate, honey. Severe patients are prescribed parenteral nutrition.

Treatment of the disease includes detoxification, anti-inflammatory and regenerative measures.

Drug therapy for Stevens-Johnson syndrome:

glucocorticosteroids - "Prednisolone", "Betamethasone", "Dexamethasone",
water-electrolyte solutions, 5% glucose solution, hemodez, blood plasma, protein solutions,
broad spectrum antibiotics
antihistamines - Dimedrol, Suprastin, Tavegil,
NSAIDs.

Medicines are administered to patients until the general condition improves. Then doctors reduce the dosage. And after complete recovery, the medication is stopped.

Local treatment consists of local anesthetics- "Lidocaine", antiseptics - "Furacilin", "Chloramine", hydrogen peroxide, potassium permanganate, proteolytic enzymes "Trypsin", preparations for regeneration - rosehip oil or sea buckthorn. Patients are prescribed ointments with corticosteroids - Akriderm, Adventan, combined ointments - Triderm, Belogent. Erosions and wounds are treated with aniline dyes: methylene blue, fucorcin, brilliant green.

With conjunctivitis, an ophthalmologist's consultation is required. Artificial tears, antibacterial and antiseptic, are dripped into the eyes every two hours. eye drops according to the scheme. With absence therapeutic effect prescribe eye drops "Dexamethasone", eye gel "Oftagel", eye ointment with prednisolone, as well as erythromycin or tetracycline ointment. The oral cavity and urethral mucosa are also treated with antiseptics and disinfectants. It is necessary to rinse several times a day with "Chlorhexidine", "Miramistin", "Clotrimazole".

With Stevens-Johnson syndrome, methods of extracorporeal blood purification and detoxification are often used. To remove immune complexes from the body, plasma filtration, plasmapheresis, and hemosorption are used.

The prognosis of pathology depends on the prevalence of necrosis. It becomes unfavorable if there is a large area of the lesion, a significant loss of fluid and pronounced disorders of the acid-base balance.

The prognosis of Stevens-Johnson syndrome is unfavorable in the following cases:

patients over 40 years of age
the rapid development of pathology,
tachycardia more than 120 beats per minute,
epidermal necrosis over 10%,
the level of glucose in the blood is more than 14 mmol / l.

Adequate and timely treatment contributes to the full recovery of patients. In the absence of complications, the prognosis of the disease is favorable.

Stevens-Johnson syndrome is a serious disease significantly worsening the quality of life of patients. Timely and comprehensive diagnosis, adequate and complex therapy avoid the development dangerous complications and severe consequences.

Video: about Stevens-Johnson syndrome

Video: Lecture on Stevens-Johnson Syndrome

This is an acute bullous lesion of the mucous membranes and skin of an allergic nature. It proceeds against the background of a serious condition of the diseased with the involvement of the oral mucosa, eyes and urinary organs. Diagnosis of Stevens-Johnson syndrome includes a thorough examination of the patient, an immunological blood test, a skin biopsy, and a coagulogram. According to the indications, X-rays of the lungs, ultrasound of the bladder, ultrasound of the kidneys, biochemical analysis of urine, consultations of other specialists are performed. Treatment is carried out by methods of extracorporeal hemocorrection, glucocorticoid and infusion therapy, antibacterial drugs.

ICD-10

L51.1 Bullous erythema multiforme

General information

Data on Stevens-Johnson syndrome were published in 1922. Over time, the syndrome was named after the authors who first described it. The disease is a severe variant of erythema multiforme exudative and has a second name - "malignant exudative erythema". Together with Lyell's syndrome, pemphigus, bullous variant of SLE, allergic contact dermatitis, Hailey-Hailey disease, and others, clinical dermatology classifies Stevens-Johnson syndrome as bullous dermatitis, common clinical symptom which is the formation of blisters on the skin and mucous membranes.

Stevens-Johnson syndrome occurs at any age, most often in persons 20-40 years old and extremely rare in the first 3 years of a child's life. According to various data, the prevalence of the syndrome per 1 million population ranges from 0.4 to 6 cases per year. Most authors note a higher incidence among men.

The reasons

The development of Stevens-Johnson syndrome is due to an allergic reaction of an immediate type. There are 4 groups of factors that can provoke the onset of the disease: infectious agents, medications, malignant diseases and unknown causes.

AT childhood Stevens-Johnson syndrome often occurs on the background of viral diseases: herpes simplex, viral hepatitis, adenovirus infection, measles, influenza, chicken pox, mumps. The provoking factor can be bacterial (salmonellosis, tuberculosis, yersiniosis, gonorrhea, mycoplasmosis, tularemia, brucellosis) and fungal (coccidioidomycosis, histoplasmosis, trichophytosis) infections.

In adults, Stevens-Johnson syndrome is usually due to medication or malignancy. Of the drugs, the role of the causative factor is primarily assigned to antibiotics, non-steroidal anti-inflammatory drugs, CNS regulators and sulfonamides. The leading role among oncological diseases in the development of Stevens-Johnson syndrome is played by lymphomas and carcinomas. If a specific etiological factor of the disease cannot be established, then they speak of the idiopathic Stevens-Johnson syndrome.

Symptoms

Stevens-Johnson syndrome is characterized by an acute onset with rapid development of symptoms. At the beginning, there is malaise, a rise in temperature to 40 ° C, headache, tachycardia, arthralgia and muscle pain. The patient may experience sore throat, cough, diarrhea, and vomiting. After a few hours (maximum after a day), rather large blisters appear on the oral mucosa. After their opening, extensive defects are formed on the mucosa, covered with white-gray or yellowish films and crusts of gore. The red border of the lips is involved in the pathological process. Due to severe mucosal damage in Stevens-Johnson syndrome, patients cannot eat or even drink.

Eye damage at the beginning proceeds according to the type of allergic conjunctivitis, but is often complicated by secondary infection with the development of purulent inflammation. For Stevens-Johnson syndrome, the formation of erosive-ulcerative elements of small size on the conjunctiva and cornea is typical. Possible damage to the iris, the development of blepharitis, iridocyclitis, keratitis.

The defeat of the mucous organs of the genitourinary system is observed in half of the cases of Stevens-Johnson syndrome. It proceeds in the form of urethritis, balanoposthitis, vulvitis, vaginitis. Scarring of erosions and ulcers of the mucosa can lead to the formation of urethral stricture.

The skin lesion is represented by a large number of rounded raised elements resembling blisters. They are purple in color and reach a size of 3-5 cm. A feature of the elements of the skin rash in Stevens-Johnson syndrome is the appearance of serous or bloody blisters in their center. The opening of the blisters leads to the formation of bright red defects, covered with crusts. The favorite localization of the rash is the skin of the trunk and perineum.

The period of appearance of new rashes of Stevens-Johnson syndrome lasts approximately 2-3 weeks, the healing of ulcers occurs within 1.5 months. The disease can be complicated by bleeding from the bladder, pneumonia, bronchiolitis, colitis, acute renal failure, secondary bacterial infection, loss of vision. As a result of developed complications, about 10% of patients with Stevens-Johnson syndrome die.

Diagnostics

The clinician-dermatologist can diagnose Stevens-Johnson syndrome based on characteristic symptoms detected by careful dermatological examination. Questioning the patient allows you to determine causal factor that caused the development of the disease. A skin biopsy helps confirm the diagnosis of Stevens-Johnson syndrome. At histological examination there is necrosis of epidermal cells, perivascular infiltration with lymphocytes, subepidermal blistering.

AT clinical analysis blood, nonspecific signs of inflammation are determined, a coagulogram reveals clotting disorders, and a biochemical blood test - reduced content proteins. The most valuable in terms of diagnosing Stevens-Johnson syndrome is an immunological blood test, which detects a significant increase in T-lymphocytes and specific antibodies.