21. Epidemiologic Notes And Reports -- Fansidar-Associated Fatal React Ion In An HIV Four nonfatal cases of stevensjohnson syndrome (severe erythema multiforme) inAIDS patients receiving Fansidar prophylaxis have been reported (1). Severe http://www.cdc.gov/mmwr/preview/mmwrhtml/00001279.htm

Epidemiologic Notes and Reports Fansidar-Associated Fatal React ion in an HIV-Infected Man In March 1987, a 48-year-old homosexual man with oral thrush and a single dermatome zoster infection was found to be human immunodeficiency virus (HIV)- seropositive by enzyme immunoassay and Western blot. He had a depressed T4 lymphocyte count of 359 cells/mm3 (normal: greater than or equal to800 T4 cells/mm3), and weekly pentamidine aerosol treatments were begun for prophylaxis against Pneumocystis carinii pneumonia (PCP). In late July 1987, the patient's T4 count had decreased to 311 cells/mm3, and weekly pyrimethamine 25 mg/sulfadoxine 500 mg (Fansidar*) was added to his prophylactic regimen. In late August, while still on weekly pentamidine aerosols and oral Fansidar, he developed a maculopapular rash on his neck. During the next 10 days, the rash spread to his arms, legs, and trunk, and multiple bullae developed. He took one or two additional doses of Fansidar during this time. In early September, the patient was hospitalized with oropharyngeal blisters and extensive cutaneous lesions and was diagnosed initially as having disseminated zoster; treatment with intravenous acyclovir was begun. The next day, a skin biopsy showed toxic epidermal necrolysis. Despite aggressive intensive care, the patient rapidly developed fever, hypotension, and acute renal failure and died 48 hours after admission. Reported by: Malaria Br and Parasitic Diseases Br, Div of Parasitic Diseases; AIDS Program, Center for Infectious Diseases, CDC.

22. HONselect - Stevens-Johnson Syndrome Language MeSH term Accepted terms English stevensjohnson syndrome,- Stevens Johnson Syndrome. Français STEVENS-JOHNSON, SYNDROME, http://www.hon.ch/HONselect/RareDiseases/C07.465.864.558.html

List of rare diseases: English Deutsch Language: MeSH term: Accepted terms: English: Stevens-Johnson Syndrome - Stevens Johnson Syndrome Français: STEVENS-JOHNSON, SYNDROME - ECTODERMOSE EROSIVE PLURIORIFICIELLE - FIESSINGER-RENDU, SYNDROME Deutsch: Stevens-Johnson-Syndrom - Erythema multiforme exsudativum majus Español: SINDROME DE STEVENS-JOHNSON Português: SINDROME DE STEVENS-JOHNSON HONselect ressources Definition: Yes Articles: Yes Images: No News: No Conferences: No Clinical trials: No Web sites: English Yes Français No Deutsch No Español No Português No Home About us Site map Feedback ... HONewsletter http://www.hon.ch/HONselect/RareDiseases/C07.465.864.558.html Last modified: Thu Jul 25 2002

23. HON Allergy Glossary Drug Allergy HONselect Drug Hypersensitivity. stevensjohnson syndrome. Insulinimage. (ntri.tamuk.edu). Drug Eruptions. stevens-johnson syndrome. A http://www.hon.ch/Library/Theme/Allergy/Glossary/drug_allergy.html

Allergy : A B C ... W X Y Z Pollen Calendar More on this topic Relevant sites from HON's MedHunt: Drug Allergy Drugs Allergy Multimedia from HONselect: Drug Hypersensitivity Stevens-Johnson Syndrome Insulin image (ntri.tamuk.edu) Drug Eruptions External survey "Questionnaire on mood" conducted by the "IMSP- Faculty of Medicine - University of Geneva" Drug Allergy Certain drugs can cause a severe allergic reaction, known as an anaphylatic reaction . First exposure to a drug does not cause this reaction but subsequent exposure may. However an anaphylact oid reaction can occur following the first injection of certain drugs (e.g. polymyxin, Pentamidine, Opioids and contrast media used for x-rays). Although many organ systems can be involved in an allergic drug reaction, the skin is most commonly affected. Dermatologic reactions include urticaria angioedema dermatitis (allergic contact dermatitis, photodermatitis, exfoliative dermatitis), fixed drug eruption, and erythema multiforme (characterized by a rash and patches of red skin all over the body). Stevens-Johnson Syndrome A severe allergic drug reaction characterized by blisters breaking out on the lining of the mouth, throat, anus, genital area and eyes. A severe form of Erythema multiforme. Drugs that can cause this reaction include the penicillins

24. Member Sign In stevensjohnson syndrome Affects More than Just Skin from Medscape General MedicineTM Posted 08/22/1997 Leslie C. Grammer, MD, Northwestern University. http://www.medscape.com/viewarticle/408712

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

25. Member Sign In Abstract and Introduction Case Report Discussion References. Intravenous ImmunoglobulinTherapy for stevensjohnson syndrome from Southern Medical Journal http://www.medscape.com/viewarticle/410743

If you are having trouble logging in: In order to use Medscape, your browser must be set to accept "cookies." To find out how to adjust your browser settings, please click here Log In Username Password Forgot your password? Not a Member? Register Now for free access to: MEDLINE (Optimized for Physicians) 200+ Free CME Courses 25 Medical Specialty Sites 100+ Medical Journals Conference Coverage Daily Medical News About Medscape Help WebMD Health

26. Arch Dermatol -- Page Not Found Intravenous Immunoglobulin Treatment for stevensjohnson syndrome and Toxic EpidermalNecrolysis A Prospective Noncomparative Study Showing No Benefit on http://archderm.ama-assn.org/issues/current/abs/dst10216.html

Select Journal or Resource JAMA Archives of Dermatology Facial Plastic Surgery Family Medicine (1992-2000) General Psychiatry Internal Medicine Neurology Ophthalmology Surgery MSJAMA Science News Updates Meetings Peer Review Congress The page you requested was not found. The JAMA Archives Journals Web site has been redesigned to provide you with improved layout, features, and functionality. The location of the page you requested may have changed. To find the page you requested, click here HOME CURRENT ISSUE PAST ISSUES ... HELP Error 404 - "Not Found"

27. The Health Library — Skin & Connective Tissue Stevens Johnson Syndrome and Toxic Epidermal Necrolysis SyndromeSteven Johnson SyndromeFoundation PDF. stevensjohnson syndromeWild Iris Medical Education. http://healthlibrary.stanford.edu/resources/internet/bodysystems/dermatology.htm

Diseases and Disorders Use these links to jump directly to your topic of interest: Acne Aging Skin Anatomy Blistering Diseases ... Sweat Gland Diseases Skin and Connective Tissue Diseases: Page 2 Page 3 Page 4 Skin Disease (General) Organizations National Intitute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) American Academy of Dermatology (AAD) American Osteopathic College of Dermatology (AOCD) American Society for Dermatologic Surgery (ASDS) ... New Zealand Dermatological Society (NZDS) Overviews Skin, Hair and Nail Topics:MEDLINEplus Skin Diseases (General):MEDLINEplus Index to Skin Conditions and Treatments:NZDS Allergic Skin Disease : A Multidisciplinary Approach:netLibrary ... Skin Rashes and Other Changes: Self-Care Flowchart:American Academy of Family Physicians Anatomy of the Skin Anatomy of the Skin:University of Maryland Body Guide: Skin (Integumentary System):Wake Forest Medical Center Acne Acne:MEDLINEplus AcneNet:AAD Questions and Answers About Acne:NIAMS Acne, Zits and Pimples:NZDS ... Acne Scar Treatments:Acne.org Aging Skin AgingSkinNet:AAD Aging and Sun-Damaged Skin:ASDS Aging Eyelids:ASDS Mature Skin:AAD ... Botulinum Toxin:AAD Blistering Diseases Blistering Disorders:Dermatology Channel Autoimmune Bullous Dermatoses:American Academy of Family Physicians Vesicles (Blisters):MEDLINEplus Medical Encyclopedia Pemphigoid What is Pemphigoid?:National Pemphigus Foundation

28. Online Dermatology Image Library HAND stevensjohnson syndrome © 2001-02, Johns Hopkins University Schoolof Medicine Dermatlas, Image Name sjs_3_030223, File Type jpg. http://dermatlas.med.jhmi.edu/derm/result.cfm?Category=10

29. Online Dermatology Image Library Next Result Set. HAND stevensjohnson syndrome © 2001-02, Johns Hopkins UniversitySchool of Medicine Dermatlas, Image Name sjs_3_030223, File Type jpg. http://dermatlas.med.jhmi.edu/derm/result.cfm?Diagnosis=34

30. BBC Health - Ask The Doctor - Stevens-Johnson Syndrome Ask the Doctor. Q Rash stevens-johnson syndrome My husband hasbeen taken into hospital after developing a strange rash which http://www.bbc.co.uk/health/ask_doctor/rash_stevens.shtml

CATEGORIES TV RADIO COMMUNICATE ... INDEX SEARCH MONDAY 31st March 2003 Text only BBC Homepage Health Homepage Ask the Doctor ... Help Like this page? Send it to a friend! Ask the Doctor Q: Rash - Stevens-Johnson Syndrome... My husband has been taken into hospital after developing a strange rash which spread to his mouth and caused masses of blisters in his mouth, eyes and genitals. The doctors have said that they think he has had a severe reaction to some antibiotics he was taking for a chronic chest problem (the antibiotics were called co-trimoxazole, I think). Is this an allergy and how quickly will it settle? Maisie Dr Trisha Macnair responds It sounds as though your husband has a condition known as Stevens Johnson syndrome, which is a severe form of a rash known as erythema multiforme. The cause is what is known as a cell-mediated hypersensitivity reaction to a distinct immunological stimuli, which in simple terms is a form of allergy which often takes some days or weeks to develop. Although the illness can be very severe, especially at first, it usually settles over a period of about a month. Sometimes the rash comes back again at a later date. Drugs may trigger it Stevens-Johnson Syndrome can be triggered by various drugs, especially some types of antibiotics, such as those containing penicillin or, as is the case with co-trimoxazole, sulphonamides. Salicylates (such as aspirin) and barbiturate drugs can also cause it, as can viral infections (Herpes simplex, the cold sore virus is a notorious trigger), cancers and other general illness. It's important to try to identify the trigger so that it may be avoided in future but often it is never pinned down.

31. Sight And Comfort: Complex Procedures In End-stage StevensJohnson Syndrome Case Report. Sight and comfort complex procedures in endstage Stevens-Johnsonsyndrome. The stevens-johnson syndrome. Ocular prognosis and treatment. http://www.nature.com/cgi-taf/DynaPage.taf?file=/eye/journal/v17/n1/full/6700264

32. Sight And Comfort: Complex Procedures In End-stage StevensJohnson Syndrome Sight and comfort complex procedures in endstage stevens-johnson syndrome. G Geerling1,2 , CSC Liu 3 , JKG Dart 1 , P Sieg 2 , J Herold 3 and JRO Collin 1. http://www.nature.com/cgi-taf/DynaPage.taf?file=/eye/journal/v17/n1/abs/6700264a

33. Episodic Conjunctival Inflammation After Stevens-Johnson Syndrome Episodic Conjunctival Inflammation after stevensjohnson syndrome. C.Stephen Foster, MD. We studied the histopathologic, ultrastructural http://www.uveitis.org/Enhanced/Backup/webeyemd_htmbank/conjSJS.htm

Episodic Conjunctival Inflammation after Stevens-Johnson Syndrome C. Stephen Foster, M.D.

34. ORALM "Nevaprine-Associated Stevens-Johnson Syndrome (Research Letter)" NevaprineAssociated stevens-johnson syndrome (Research Letter). Nevaprine-Associatedstevens-johnson syndrome (Research Letter) Lancet (02/21/98) Vol. http://www.hivdent.org/oralm/oralmnasjsrl.htm

Nevaprine-Associated Stevens-Johnson Syndrome (Research Letter) "Nevaprine-Associated Stevens-Johnson Syndrome (Research Letter)" Lancet (02/21/98) Vol. 351, No. 9102, P. 567; Warren, Kelly J.; Boxwell, Debra E.; Kim, Nancy; et al. Researchers from the Medical College of Wisconsin and the U.S. Food and Drug Administration report incidence of Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) in an HIV-positive patient receiving zidovudine, lamivudine, and nevirapine. The patient had tender oral ulcers and haemorrhagic crusts, which were believed to be a result of using nevirapine. The researchers also note 19 other cases of nevirapine-associated SJS and TEN reported to the FDA since the drug's approval in June 1996. There has been only one published report of zidovudine-mediated TEN since the drug was approved in 1987, and there are no reports of lamivudine-induced SJS or TEN since its 1995 introduction. The researchers note that the likelihood of severe mucocutaneous side effects related to use of nevirapine in persons infected with HIV-1 appears to be among the highest reported for any medication.. Back to the Oral Manifestations/Care Main Page Last Updated December 01, 1998

35. ORALM "Nevaprine-Associated Stevens-Johnson Syndrome (Research Letter)" Stevens-JohnsonAsociado a Nevapirina Lancet (02/21/98) Vol. 351, No. http://www.hivdent.org/oralm/spain/oralmnasjsrl.htm

Síndrome de Stevens-Johnson Asociado a Nevapirina " Síndrome de Stevens-Johnson Asociado a Nevapirina " Lancet (02/21/98) Vol. 351, No. 9102, P. 567; Warren, Kelly J.; Boxwell, Debra E.; Kim, Nancy; et al. Investigadores del Medical College of Wisconsin y la FDA (Food and Drug Administration)de Estados Unidos, reportaron la incidencia del Síndrome de Stevens Hohnson (SSJ) y Necrólisis Epidérmica Tóxica (NET) en un paciente HIV-positivo que estaba recibiendo Sidovudina, Lamivudina y Nevirapina. El paciente presentaba úlceras orales suaves y costras hemorrágicas, las cuales se pensó fueron resultado del uso de nevirapina. Los investigadores también notaron otros 19 casos de SSJ y NET asociados a Nevirapina, reportados a la FDA desde que la droga fué aprobada en Junio de 1996. Solamente ha habido un reporte publicado de NET asociada a Lamivudina desde que la droga fué aprobada en 1987, y no hay reportes de SSJ o NET inducidos por Lamivudina desde su introducción en 1995. Los investigadores apuntan que la probabilidad de efectos colaterales mucocutáneos relacionados al uso de Nevirapina en personas infectadas con VIH-1 parece estar dentro de los más altos reportados para cualquier medicamento.

36. Boston Foundation For Sight stevensjohnson syndrome stevens-johnson syndrome and toxic epidermalnecrolysis typically affect children and young adults. These http://www.bostonsight.org/glossary.htm

GLOSSARY The Boston Scleral Lens The Boston Scleral Lens is a specially designed contact lens device that provides a non-surgical means of restoring vision in eyes affected by corneal disorders. The lens is about the size of a quarter; it covers the insensitive white part of the eye (the sclera) and arches over the damaged cornea, thereby creating a space that is filled with soothing, artificial tears. Thus, optimal vision and comfort are achieved. The lens is made of highly oxygen-porous plastic which allows the cornea to breathe. Stevens-Johnson syndrome Stevens-Johnson syndrome and toxic epidermal necrolysis typically affect children and young adults. These diseases are the result of an extremely adverse reaction to a medication. The most common medications causing these diseases are sulfa-based drugs, but medications as common as aspirin and ibuprofen have also been implicated. In the acute phase, which may be life threatening, these patients suffer from severe, burn-like lesions all over the body. As with burn patients, it takes many months for these to heal. Following the resolution of the acute phase, as many as half of these patients suffer from chronic eye disease.

37. Erythema Multiforme presentation. This variation has led to EM being divided into two overlappingsubgroups (EM minor and stevensjohnson syndrome). These http://www.aocd.org/skin/dermatologic_diseases/erythema_multiform.html

[ click a disease picture to see larger view ] Erythema Multiforme Erythema multiforme (EM) is an acute, self-limiting, inflammatory skin eruption. The rash is made of spots that are red welts, sometimes with purple or blistered areas in the center. It often also affects the mouth, eyes and other moist surfaces. Erythema multiforme has been so named because of the "multiple forms" it appears in; there is a large degree of variety in its clinical presentation. This variation has led to EM being divided into two overlapping subgroups (EM minor and Stevens-Johnson syndrome). These are different faces of the same disease. EM is relatively common problem for a dermatologist. Half the cases are in young people (under 20). It rare both under the age of 3 and over the age of 50. Males are slightly more affected than females and there is no racial predilection. One third of EM sufferers will have a recurrence of the disease. Seasonal epidemics are common. Erythema multiforme minor : EM minor as the name suggests is the less severe of the two types and accounts for 80% of EM. The rash appears over a few days, however in some patients several crops follow each other during one attack. There may be minor burning or itch. It is most intense over the backs of the hands and feet. There are usually round "bulls eye" target shaped rings on the palms. In severe cases some blisters may be present both on the skin and lips. The rash lasts for 1 to 2 weeks and then recedes leaving residual brown pigmentation.

38. WebMD/Lycos - Article These include cases of stevensjohnson syndrome, a rare and potentially deadlydisorder characterized by inflammation of the mucous membranes of the mouth http://webmd.lycos.com/content/article/53/61178.htm

Lycos Home Site Map My Lycos SEARCH HEALTH FOR: Health Home Health News Conditions A-Z Wellness Topics ... Sign In Post a message, chat... Join Free newsletters and more Event Highlight Tuesday, April 01, 2003 1:00 p.m. Sleep and Health for Older Americans Browse Drug Database Drug Alerts Drug FAQs ... Product Recalls Serious Reactions From Arthritis Drug Reviewed by Brunilda Nazario, MD Nov. 15, 2002 The FDA and the makers of the drug Bextra, are warning about newly reported allergic reactions to a nine-month-old arthritis drug. The label for Bextra is being updated with information about these serious but rare side effects, including life-threatening skin reactions. Bextra is prescribed to treat osteoarthritis, rheumatoid arthritis, and menstrual pain. Since Bextra was introduced in March, Pharmacia, Bextra's manufacturer, has reported to the FDA serious and life-threatening skin and hypersensitivity reactions to the drug. These include cases of Stevens-Johnson syndrome, a rare and potentially deadly disorder characterized by inflammation of the mucous membranes of the mouth, throat, genitals, intestinal tract, and membrane lining the eyelids, which can lead to lesions and blisters. Other side effects were toxic epidermal necrolysis a condition in which skin dies and peels off much like that of a severe burn victim; erythema multiforme a less serious condition similar to Stevens-Johnson syndrome; and scaly skin.

39. Stevens-Johnson Syndrome And Respiratory Failure In A 9-Year-Old Boy stevensjohnson syndrome and Respiratory Failure in a 9-Year-Old Boy. 1. GinsburgCM stevens-johnson syndrome in children. Pediatr Infect Dis 1982; 1155-158. http://www.sma.org/smj/97july21.htm

Stevens-Johnson Syndrome and Respiratory Failure in a 9-Year-Old Boy MARCUS S. SCHAMBERGER, MD, JASLEEN GOEL, MD, STEPHEN R. BRADDOCK, MD, DAVID S. PARSONS, MD, and JOSEPH D. TOBIAS, MD, Columbia, Mo STEVENS-JOHNSON SYNDROME or erythema multiforme major is a systemic illness with vesico-bullous involvement of the skin. Various infectious agents such as herpes simplex virus, Mycoplasma pneumoniae, and adenovirus have been implicated as possible etiologic agents. Although the cutaneous lesions are the most striking feature, systemic involvement with gastrointestinal, renal, and musculoskeletal manifestations may also occur.1,2 Upper respiratory tract involvement with mucosal membrane lesions is common; involvement of the lower respiratory system with respiratory failure is much less common. We present a case of Stevens-Johnson syndrome in a 9-year-old boy who had respiratory failure that necessitated mechanical ventilatory support. CASE REPORT Mycoplasma pneumoniae titer. Initial antibiotic therapy included erythromycin, ceftazidime, and vancomycin. The bronchospastic component of the disease was treated with inhaled albuterol and ipratropium bromide, along with intravenous methylprednisolone. Marginal ventilatory function was achieved during the initial hospital days with positive end-expiratory pressures of up to 10 cm H2O and an FIO2 of 1.0. Serial chest x-ray films showed shifting areas of atelectasis and development of a small pneumomediastinum. The conjunctivitis and oral mucositis slowly improved. On the seventh day of hospitalization, bronchoscopy was repeated because of increasing difficulties with ventilation (increasing pressure requirements). Copious thick secretions and sloughed mucosa were removed during the procedure. Thereafter, the respiratory status began to improve and ventilatory support was gradually weaned over the next 5 days to 7 days. All antibiotics, except erythromycin, were discontinued after the

40. New Treatment For Acute Stevens-Johnson Syndrome And Toxic Epidermal Necrolysis New Treatment for Acute stevensjohnson syndrome and Toxic EpidermalNecrolysis stevens-johnson syndrome (SJS) and Toxic Epidermal http://www.aao.org/aao/education/library/memberalert/stevens_johnson.cfm

help Last Name ID Number AAO Home Online Education Center Library Member Alerts and Updates New Treatment for Acute Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are moderate and severe variations of the same adverse reaction (usually to drugs or mycoplasma pneumonia) which result in blistering and sloughing of skin and mucosal membranes, and carry a high risk of mortality. With the seemingly unstoppable acute phase often lasting several weeks, SJS and TEN have always been a challenge to treat. Despite round-the-clock application of lubricant ointments, antibiotic and steroid drops, and daily lysis of adhesions using a glass rod, the majority of patients still end up with a lifetime of ocular problems. These sequelae range from mild dry eye, ongoing inflammation, scarred eyelids, entropion with trichiasis, photophobia, and decreased vision, to chronic corneal ulcers, corneal vascularization, total limbal deficiency, complete loss of tears, significant vision loss or blindness, constant severe pain, or complete loss of one or both eyes. Now, a treatment appears to not only help bring a halt to the ocular reaction, but could prevent all or most of these sequelae from developing. This treatment involves the application of amniotic membrane to all eye and inner lid surfaces as soon as possible during the acute phase.

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