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Stevens–johnson Syndrome

Stevens–johnson Syndrome is a topic covered in the 5-Minute Emergency Consult.

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  • Stevens–Johnson syndrome (SJS) is an idiosyncratic, severe mucocutaneous disease:
    • Blistering of <10% of the body surface area (BSA)
    • 95% of patients have mucous membrane lesions:
      • Usually at 2 or more sites
    • 85% have conjunctival lesions
    • Lesions often involving face, neck, and central trunk regions become confluent over hours to days
  • On a continuum with toxic epidermal necrolysis (TEN); but thought to be a distinct disease entity from erythema multiforme (EM):
    • SJS: <10% of BSA
    • SJS–TEN overlap syndrome: 10–30% of BSA
    • TEN: >30% of BSA, can affect up to 100% BSA


  • The most common causes include medications and infections:
    • Damage to the skin is thought to be mediated by cytotoxic T lymphocytes and mononuclear cells aimed at keratinocytes expressing (drug-related) antigens
    • Cytokines from activated mononuclear cells probably contribute to cell destruction and systemic manifestations
  • Causative medications:
    • Antibiotics (e.g., penicillin, sulfonamide)
    • Anticonvulsants
    • Oxicams
    • NSAIDs
    • Allopurinol
  • Infections:
    • Mycoplasma pneumoniae
    • Herpes simplex

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Rosen, Peter, et al., editors. "Stevens–johnson Syndrome." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307702/all/Stevens_johnson_Syndrome.
Stevens–johnson Syndrome. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307702/all/Stevens_johnson_Syndrome. Accessed April 25, 2019.
Stevens–johnson Syndrome. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307702/all/Stevens_johnson_Syndrome
Stevens–johnson Syndrome [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307702/all/Stevens_johnson_Syndrome.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Stevens–johnson Syndrome ID - 307702 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307702/all/Stevens_johnson_Syndrome PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -