Teaching bangsal I

Stevens-Johnson Syndrome

Nama Anggota Kelompok

• Rachmat Nugraha P• Suryani Sudirman• Ita Juniarti D• Subhiayawati B

• Dewi Damayanti• Andi Rahmayanti• A. Trie Utami Rasyid

• Sekar Dwi Asti Adjo• Chindy Permatasari• Ramna Minggus• Nurul Hidayah• Raehana Nurhidayah• Hestina Lambona• Muh. Wirawan Harahap

PATIENT IDENTITY

• Name : Kid. AS• Gender : Male• Age : 11 years old• Religion : Moslem• Address : Andi Tonro

Sungguminasa• Job : Student• Admission date : 07/07/2012• Medical record no : 153259

History Taking• Chief Complaint: Erythema, bulla,erosion and crust in Regio

Labialis and regio truncus of Extremity superior et inferior • Brief anemnesis: since ±10 days ago the early lesion in

labial region and throughout the body. lesions in the form bulla become pustule then broken into the crust. Edema (-), pain (+), Itchy (+), febris (-), cough (-), Dyspneu (-), vomitting (-), nausea (-), history of fever and cough a 5 days ago (+)circumcision appeared 3 days before the complaint

• family history with the same disease (-), history of allergy (-), history of medication : the patient had consumed drugs given after circumcision but his family does not remember the drugs.

CURRENT STATUS

• Consciousness : Compos Mentis• General Condition : Moderate• Hygiene : Moderate• Nutrition : less• Vital sign :

BP : 100/60 mmHgPulse : 98x/minutesRR : 20x/minutesTemperature : 36,60C

DERMATO-VENEROLOGY STATUS

• Regio : Regio Labialis and regio truncus of Extremity superior et inferior

• Efl : Erythema, bulla,erosion and crust

PHYSICAL EXAMINATION

• Anemic (-), icterus (-), cyanoses (-)• Cor/ Pulmonal: Normal• Abdomen: Normal, peristaltic (+)• Extremities: Edema (-)• Lymph nodes: Enlargement (-)

Laboratory Result• WBC : 10.4 (10 3 /uL)• RBC : 4,4 6 /uL)• HB : 10,9 (g/dL)• HCT : 34,9 (%)• PLT : 488(10 3 /uL)• LYM : 13,3 (%)• Creatine : - mg/dl• GDS : - mg/dl

RESUME• Kid.AS came to hospital with Erythema, bulla,erosion and crust

in Regio Labialis and regio truncus of Extremity superior et inferior. Edema (-), pain (+), Itchy (-), febris (-), cough (-), Dyspneu (-), vomitting (-), nausea (-), history of fever and cough a 5 days ago (+)circumcision appeared 3 days before the complaint

• History of medication : had consumed drugs given after circumcision but his family does not remember the drugs.

• Physical examination: Moderate

• Dermato-venerology• Regio : Regio Labialis and regio truncus of Extremity

superior et inferior • Efl : Erythema, bulla,erosion and crust

DIAGNOSIS

Stevens-Johnson Syndrome

DISCUSSIONSJS acute life-threatening mucocutaneous reaction characterized by extensive necrosis and detachment of the epidermis. SJS severe variants of an identical pathologic process and differ only in the percentage of body surface involved. Either idiopathic or drug-induced. Pathomechanism is widespread apoptosis of keratinocytes induced by a cell-mediated cytotoxic reactions.

DISCUSSION

Confluent erythematous purpuric and target-like macules evolve into flaccid blisters and epidermal detachment mostly on the trunk and extremities, and there is associated mucous membrane involvement.

Clinical manifestation are abnormalities in the skin, mucous membranes abnormalities in orificium, and eye abnormalities. Treatment is symptomatic. Systemic treatment with glucocorticoids and high-dose intravenous immunoglobulin is controversial

RECOMMENDED EXAMINATION

• Laboratorium examination

• Histopathologically: full-thickness necrosis of

the epidermis and a sparse lymphocytic

infiltrate.

TREATMENT & MANAGEMENT

• Dexametasone 0,5 mg3x1/day

• Interhistin syrup 2x1 cth/ day

• Curvit syrup 2x1 cth/day

• Fuson cream 5gr

PROGNOSIS

Depends on rapid and right handling, the patient's condition, and distribution of the lesion.

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