Integrating antimicrobial photodynamic therapy into the adjuvant phototherapeutic approach for orofacial manifestations of toxic epidermal necrolysis and Stevens-Johnson syndrome.

Characterized by an immune reaction to medications, toxic epidermal necrolysis (TEN) and Steven-Johnson Syndrome (SJS) are potentially fatal mucocutaneous reactions, and their management remains challenging. Considering the promising studies regarding the use of laser in managing orofacial lesions, this study aimed to report two cases in which children presenting with TEN and SJS were treated using a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) concurrently with conventional supportive care. The treatment proposed herein resulted in significant clinical improvement of the children's oral condition within a few days, enabling the reintroduction of oral feeding. Within the limitations of the study, the cases reported suggest that the adjuvant combination of PBMT and aPDT may be beneficial for improving the oral condition of children afflicted with oral injuries induced by TEN and SJS.

[Toxic epidermal necrolysis: idiosyncratic reaction to drugs]. / Necrólisis epidérmica tóxica: reacción idiosincrática a neurofármacos.

Toxic epidermal necrolysis (NET) and Steven Johnson syndrome (SJS) are infrequent mucocutaneous hypersensitivity reactions with systemic involvement. They are predominantly caused by drugs. We report the case of a patient over 60 years of age who presented with extensive mucocutaneous and ophthalmic injury with hemodynamic failure, associated with the rapid onset of lamotrigine in a short period of time. Although the incidence is low, the mortality rate is high. It requires early suspicious and diagnosis in addition to an interdisciplinary therapeutic approach.

[Mycoplasma pneumoniae-induced atypical Steven-Johnson syndrome: a diagnostic challenge]. / Síndrome de Steven-Johnson atípico inducido por Mycoplasma pneumoniae: un reto diagnóstico.

BACKGROUND: Atypical Steven-Johnson syndrome is a rare disease that can be caused by Mycoplasma pneumoniae; it is characterized by respiratory symptoms, mucosal lesions of variable severity and constitutional symptoms, in the absence of cutaneous involvement. CASE REPORT: We present the case of a 35-old-man who developed mucositis in the conjunctiva, oral cavity and genitalia after the onset of respiratory symptoms. Mycoplasma pneumoniae infection was confirmed, and treatment with antibiotic and steroids was therefore started, whereby clinical manifestations subsided. CONCLUSIONS: Mycoplasma pneumoniae-induced atypical Steven-Johnson syndrome diagnosis can be challenging. The differential diagnosis of fever and oral, genital and conjunctival mucositis associated with respiratory symptoms should include infection with this bacteria in order to provide accurate and timely treatment.

Antecedentes: El síndrome de Steven-Johnson atípico es una enfermedad poco común que puede ser causada por Mycoplasma pneumoniae; se caracteriza por síntomas respiratorios, lesiones en mucosas de gravedad variable y síntomas constitucionales, en ausencia de compromiso cutáneo. Reporte de caso: Hombre de 35 años quien desarrolló mucositis en conjuntiva, cavidad oral y genitales después de la presentación de síntomas respiratorios. Se confirmó la infección por Mycoplasma pneumoniae, por lo que se inició tratamiento con antibiótico y esteroides, con lo cuales remitieron las manifestaciones clínicas. Conclusiones: El diagnóstico de síndrome de Steven-Johnson atípico inducido por Mycoplasma pneumoniae puede ser difícil. El diagnóstico diferencial de fiebre y mucositis oral, genital y conjuntival asociadas con síntomas respiratorios debe incluir infección por esta bacteria, con el fin de brindar un tratamiento certero y oportuno.

Steven Johnson Syndrome / Síndrome de Steven Johnson

Ulcerative vesiculobullous disorders are common in Dermatology and Oral Medicine. Diagnosis of these conditions is pretty effortless if they give a classic appearance as described in the literature. Steven Johnson syndrome is one such condition which is a type of erythema multiforme. It is a disorder involving mucous membrane, skin and even the multiple organs in severe form. Multiple etiologies persist so be acquainted with the cause and prohibit the root is crucial. But still drugs are considered to be common cause. Early management is vital as complications are serious for this condition even leading to death. We hereby report a typical case with classic appearance of Steven Johnson syndrome.

Doenças ulcerativas vésicobolhosas são comuns em Dermatologia e Medicina Oral. O diagnóstico destas condições é bastante fácil se apresentar uma aparência clássica, tal como descrito na literatura. Steven Johnson é um tipo de eritema multiforme. É uma desordem envolvendo as mucosas, pele e até múltiplos órgãos de forma grave. Múltiplas etiologias são apontadas como causa. Mas ainda os medicamentos são considerados como causas comuns. O tratamento precoce é vital, pois complicações são graves para essa condição, podendo levar à morte. Vimos por meio deste relatar um caso típico, com aparência clássica de Síndrome de Steven Johnson.

Síndrome de Stevens-Johnson associada ao uso de antimicrobiano / Stevens-Johnson syndrome associated with antimicrobial agent

Dentre as reações medicamentosas graves, figuram como grandes representantes as doenças mucocutâneas imunologicamente mediadas. A síndrome de Stevens-Johnson, ou eritema multiforme maior, aparece como um distúrbio sistêmico com envolvimento de pele e membranas mucosas relacionado a diversos fatores, tais como infecções virais ou bacterianas e, principalmente, a administração de medicamentos, em geral analgésicos e antibióticos. O objetivo deste artigo é relatar o aparecimento de lesões vesículo-bolhosas ulcerativas em regiões de lábios, gengiva, língua e mucosa genital em um paciente de 26 anos, leucoderma, gênero masculino, em tratamento de infecção respiratória com sulfametoxazol-trimetropima, diagnosticado como síndrome de Stevens-Johnson

Among the severe reactions to medications, immune-mediated Mucocutaneous Disorders are widely represented. Steven-Johnson's syndrome, or great multiform erythema, appears as a systemic disturbance, involving the skin and mucous membranes, and is related to several factors, such as, viral or bacterial infections and particularly the administration of medicines, in general painkillers and antibiotics. The objective of this article is report the onset of ulcerative vesicle ûblister lesions in the regions of the lips, gums, tongue and genital mucosa membrane in a 26 year-old patient, a leukoderm man, being treated with sulfamethoxazole trimethoprim for a respiratory infection, after being diagnosed as having the Steven-Johnson syndrome.