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SUPERVISOR :
Dr. Nur Rahmah M.kes,Sp.KK
Dr. Sukma Anjayani M.kes,Sp.KK
Dr. Syahriani M.kes, Sp.KK
ANAMNESIS
Main complaints
Fever
ANAMNESIS
History of previous disease:
Patients had never experienced the
same thing with the scenario.
No member of the family who have
the same complaint with the patient
Physical Examination
General Status:
1. General Situation : mild
2. Awareness : compous mentis
3. Nutritional status : Good
4. Vital Signs :
a. Blood pressure : 100/80 mmHg
b. Pulse : 76x / min
c. Temperature : 37oc
d. Breathing : 20x / min
Status Dermatology
Localization
Regio
Size
Lesion
a. Lips
b. Body
Status Dermatology
Size
: lenticular and
numular
Lession :
In the lips erytheme vesicles,
erotion, and crust, body
multiple
papul
with
erythematous base.
Differential Diagnosis
1. TEN (Toxic Epidermal Necrolisys)
Working
Diagnosis
SINDROM STEVENS
JHONSON
Treatment
1. Topical :
- Kenalog in orabase
2. Sistmik :
- NaCl 9%
- Deksametason intravena 4-6 x 5 mg sehari
- Prednison 30- 40 mg sehari
- Cyclosporin 5 mg/KgBB/day
- Immunoglobulin 3 gr/KgBB/day
Vital Sign
A
P
Systemik
- Dexamethasone Injection i/12 hours day IV
- Gentamicyn Injection/12 hours day IV
- Ringer Laktat 24 drops/ Minute
Day Care 1
Vesicle erytheme,
erotion difus,
crusta.
Tgl
Vital Sign
BP. 110/70 mmHg
Pulse 80x/minutes
Temperature 36 C
Respiratory rate 20x/minutes
Localization Facialis, thoracalis, upper and lower limb, back, upper and
lower leg.
Lesion of lips
: Vesicle erytheme, erotion difus, crusta.
Lesion of body
: Multiple papul with erythematous base, round shape,
sirkumskrip, miliar up to lentikuler.
Sindrom steven johnson
A
P
Topical
- Kenalog Cream in lesion lips
- Inerson 15 gr + Fuson cream in body (morning afternoon)
- compress NACL 0,9
Systemik
- -
Day Care 2
Vesicle erytheme,
erotion difus,
crust.
Tgl
Vital Sign
BP. 110/70 mmHg
Pulse 80x/minutes
Temperature 36 C
Respiratory rate 20x/minutes
Localization Facialis, thoracalis, upper and lower limb, back, upper and
lower leg.
Lesion of lips
: Vesicle erytheme, erotion difus, crust.
Lesion of body
: Multiple papul with erythematous base, round shape,
sirkumskrip, miliar up to lentikuler.
Sindrom steven johnson
A
P
Topical
- Kenalog Cream in lesion lips
- Inerson 15 gr + Fuson cream in body (morning afternoon)
- compress NACL 0,9
Systemik
- Dexamethasone Injection i/12 hours day I
- Gentamicyn Injection/12 hours day VI
- Ringer Laktat 24 drops/ Minute
Day Care 3
Vesicle erytheme,
erotion difus,
crust.
Tgl
Reddsh rash on the entire body, crusta in the lips, eyes can open
Vital Sign
BP. 110/70 mmHg
Pulse 84x/minutes
Temperature 36 C
Respiratory rate 20x/minutes
Localization Facialis, thoracalis, upper and lower limb, back, upper and
lower leg.
Lesion of lips
: Crust.
Lesion of body
: Multiple papul with erythematous base, round shape,
sirkumskrip, miliar up to lentikuler.
Sindrom steven johnson
A
P
Topical
- Kenalog Cream in lesion lips
- Inerson 15 gr + Fuson cream in body (morning afternoon)
- compress NACL 0,9
Systemik
- Dexamethasone Injection i/12 hours day II
- Gentamicyn Injection/12 hours day VII
- Ringer Laktat 24 drops/ Minute
Day Care 4
Tgl
Reddsh rash on the entire body, crusta on the lips began to decrease
Vital Sign
BP. 100/70 mmHg
Pulse 80x/minutes
Temperature 36 C
Respiratory rate 20x/minutes
Localization Facialis, thoracalis, upper and lower limb, back, upper and
lower leg.
Lesion of lips
: Crust.
Lesion of body
: Multiple papul with erythematous base, round shape,
sirkumskrip, miliar up to lentikuler.
Sindrom steven johnson
A
P
Topical
- Kenalog Cream in lesion lips
- Inerson 15 gr + Fuson cream in body (morning afternoon)
- compress NACL 0,9
Systemik
-
Day Care 5
RESUME
Mr. U patients 39 years of age entered Anutapura hospital with with
complaints raddish rash on the entire body experienced since 8 days
ago. Intially the patients has a fever and got Paracetamol and vitamin
from the clinic. After that the patients has an appear reddish rash and
itchy. Complaints aggraveted after peeling lips like a blister. Red eyes
and difficult open the eyes. There is no previous history of the disease
and no family history of disease.
On physical examination, the patient's status generalist awareness
compos mentis, BP (100/80 mmHg), temperature (37 C), respiratory
(20x / min), pulse (76x/min). For the status of dermatology obtained
intentions skin disorders in the eye there is erythema and erosion
diffuse, on the lips obtained vesicular erythema and erosion diffuse
accompanied by crusta, and on the neck, chest, abdomen, back,
upper extremities, lower extremities obtained papules multiple, round
shape , size milliar and lenticular, with circumscribed limits.
DISCUSSION
In this case the diagnosis of
Sindrom stevens Jhonson based on
history and clinical features. The
history and clinical symptoms of
Sindrom Steven Jhonson found in
this case
DISCUSSION
Theory
Case
Stevens-Johnson
syndrome
is
an
immunecomplexmediated hypersensitivity
complex that typically
involves the skin and the
mucous membranes.
In
these
patients
Stevens
Johnson
syndrom occurs in the
skin and mucosa.
DISCUSSION
Theory
Case
Learning Case
Theory
Case
PATOMEKANISM OF
EPIDERMAL
NECROLISIS
Learning Case
Theory
Case
The
eruption
is
initially
symmetrically distributed on
the face, the upper trunk, and
the proximal part of limbs. The
initial
skin
lesions
are
characterized by erythematous,
dusky red, purpuric macules,
irregularly
shaped,
which
progressively
coalesce.
It
begins with erythema followed
by painful erosions of the oral,
ocular, and genital mucosa.
When
first
admitted
to
hospital
pattients
were
admitted with symptoms of
fever, spot appear all over
the body, puffy lips and
vesicle and pain the eyes.
These symptoms appear after
consuming
the
drug
Paracetamol.
Diagnosis :
1. Anamnesis
. History taking medication before symptoms
appear
. Clinical Symptomps
2. Physical Examination
. Cutaneus Lession: Erythematous , Vesicles , Bulla
. Mucous membrane involvement : It begins with
erythema followed by painful erosions of the oral,
ocular, and genital mucosa.
. Conjunctivitis
Histopatologi
Discussion
From the results of the history and physical
examination and an explanation theory in
case then this dignosis patients with Stevens
Johnson syndrom.
Discussion
Discussion
Cliniycally begins within 8 weeks (usually 4 to
30 days) after the onset of drug exposure for
the firs time. The eruption is initially
symmetrically distributed on the face, the
upper trunk, and the proximal part of limbs.
The initial skin lesions are characterized by
erythematous, dusky red, purpuric macules,
irregularly shaped, which progressively
coalesce. It begins with erythema followed by
painful erosions of the oral, ocular, and
Discussion
Figure 1. Extensive erosions and necroses of the lower lip and oral
mucosa, massive erosions covered by crusts on the lips.
Discussion
Differential Diagnosis
TEN (Toxic Epidermal Necrolisys)
Therapy in patients
Topical Treatment
steven johnson syndrome treatment based on
the patient's general condition
Topical treatment:
Kenalog in orabase At lip sores
Systemic treatment
Cyclosporin A 5mg/KgBB/day
Intravenous Immunoglobulin 3gr/KgBB/day
Antibiotics have rarely cause
allergies, bactericidal properties and
no or little nephrotoxic (ciprofloxacin
2x400 mg intravenously / 24 hours).
Prognosis
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