CURRENT Essentials of Critical Care.pdf

262 Current Essentials of Critical Care■■■Erythema Multiforme & Stevens-Johnson SyndromeEssentials of Diagnosis• Erythema multiforme: hypersensitivity reaction to medicationsand infectious agents• Low-grade fever, malaise, upper respiratory symptoms, followedby nonspecific symmetric eruption of erythematous macules,papules, urticarial plaques• Evolves into concentric rings of erythema with papular, dusky,necrotic or bullous centers (“target lesions”) over 1–2 days• May also appear as annular, polycyclic, or purpuric lesions (multiforme)• Stevens-Johnson syndrome: high fever, headache, myalgias,sore throat (1 mucosal surface affected), with conspicuousstomatitis, beginning with vesicles on lips, tongue, buccal mucosa,rapidly evolving into erosions and ulcers covered by hemorrhagiccrustsDifferential Diagnosis• Erythema multiforme without classic target lesions: urticarialeruptions, viral exanthems, vasculitis• Mucocutaneous ulcerations: Reiter syndrome, Behçet syndrome,herpes gingivostomatitis• Bullous impetigo, bullous pemphigoid, pemphigus vulgaris,toxic epidermal necrolysisTreatment• Supportive care, symptomatic therapy, optimize nutrition• Discontinue potential offending agents• Monitor closely for progression to secondary bacterial infectionor toxic epidermal necrolysis■ PearlErythema multiforme occurs in all age groups, while Stevens-Johnsonsyndrome most often affects children and young men.ReferencePrendiville J: Stevens-Johnson syndrome and toxic epidermal necrolysis. AdvDermatol 2002;18:151. [PMID: 12528405]