Case Report of External Compression in Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis Overlap

Case Report

J Fam Med. 2020; 7(7): 1221.

Case Report of External Compression in Stevens-Johnson Syndrome-Toxic Epidermal Necrolysis Overlap

Kan CK¹, Lee MS², Mostaghimi A³ and Larson AR²*

¹Boston University School of Medicine, USA

²Department of Dermatology, Boston Medical Center, USA

³Department of Dermatology, Brigham and Women’s Hospital, USA

*Corresponding author: Larson AR, Department of Dermatology, Boston Medical Center, 609 Albany St. J-207, Boston, MA, USA

Received: May 12, 2020; Accepted: October 17, 2020; Published: October 24, 2020


Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) form a spectrum of severe mucocutaneous reactions, characterized by epidermal detachment and necrosis. Though disease mortality and morbidity are high, treatment remains mostly of supportive measures with varying efficacy. Here we present the case of a patient with SJS/TEN overlap as well as ongoing external cast compression for her forearm. While the rest of her body showed extensive skin involvement, the casted arm region had reduced skin severity and progression throughout the rest of the disease course. Although cast compression has been previously used in burn patients, this case report examining cast compression in a patient with SJS/TEN may offer insight into an adjunctive supportive treatment for this highly morbid disease.

Keywords: Stevens-johnsons syndrome; Toxic epidermal necrolysis; External compression; Case report

Case Presentation

A 22-year-old woman with recent Monteggia fracture complicated by osteomyelitis following multiple open reduction internal fixation and debridement operations presented with a three-day duration of fevers and bilateral cheek redness. Seven days prior to presentation, she was started on trimethoprim-sulfamethoxazole for ongoing osteomyelitis. At presentation, she denied dyspnea, chest pain, diarrhea, abdominal pain, and nausea or vomiting. Vital signs were remarkable for fever of 102 degrees Fahrenheit. Her cheeks exhibited pink well-demarcated patches without nasolabial fold sparing or pruritus. Labs were significant for white blood cell count of 15, and hemoglobin of 10. Within the next few hours, her rash spread from her cheeks downwards to her entire back, central chest, abdomen, and lower legs.

The antibiotic was discontinued immediately upon hospital admission. A diagnosis of Stevens-Johnsons Syndrome /Toxic- Epidermal-Necrolysis (SJS/TEN) overlap was made, given total body surface area of approximately 25% affected and multiple blistering and denuded sites present throughout her upper arms, trunk, and back (Figure 1). Her course was complicated by right corneal damage requiring amniotic membrane placement. Due to her recent arm operation, her right forearm was enclosed in a short metal cast from her elbow to hand sparing the fingers (Figure 2). Interestingly, the skin underneath the casted area remained well-demarcated and less affected from erythema or sloughing, despite extensive involvement elsewhere; and this lack of progression in this area continued throughout the rest of the disease course (Figures 3 and 4).