Advertisement

European Archives of Paediatric Dentistry

, Volume 14, Issue 5, pp 355–358 | Cite as

Immunoglobulin injection for the treatment of multiple oral ulcers in Stevens–Johnson syndrome

  • M. CicciùEmail author
  • F. Chiera
  • R. Gallizzi
  • A. Cicciù
  • C. D. Salpietro
Case Report

Abstract

Background

Stevens–Johnson syndrome (SJS) is a rare genetic disorder. The syndrome presents with severe purulent conjunctivitis, stomatitis with mucosal necrosis, and purpuric macules. This syndrome is associated with hypersensitive reaction usually stimulated by infection, vaccination, systemic diseases, physical agents, foods or drugs. However, only few cases reported can be related to infectious agents, but the causative role of infectious microorganisms seems relevant in paediatric patients. Authors want to underline the positive response of a new way of therapy by immunoglobulin injection.

Case report

This case describes a 10-year-old girl with several erosions disseminated in the oral cavity mucosa. The girl had skin erosions that led to the clinical diagnosis of SJS. The past medical history of the patient revealed that those symptoms occured every 6 months over the last 2 years with 2 consecutive weeks of acute manifestations. At that moment, the paediatrician decided for cortisone administration in order to manage the acute symptoms, but after 6 months a new acute episode was observed. For this reason the patient was referred to the Department of Genetics and Immunological Paediatrics.

Treatment

Oral ulcers had been topically treated with an oral balance gel. Intravenous injection of immunoglobulin was then applied and the patient was discharged after 5 days of treatment with the total symptoms in remission.

Follow-up

The patient was followed up 3 monthly over the next 24 months. At that time no relapse of the SJS was observed.

Conclusion

The seriousness of this condition imposes a prompt recognition. Paediatric dentists should recognise the clinical signs of possible SJS as soon as possible in order to perform a quick diagnosis and initiate treatment.

Keywords

Stevens–Johnson syndrome Ulcers Conjunctivitis Hyperkeratosis 

References

  1. Bastuji-Garin S, Rzany B, Stern RS, et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129(1):92–6.PubMedCrossRefGoogle Scholar
  2. Koh MJ, Tay YK. An update on Stevens–Johnson syndrome and toxic epidermal necrolysis in children. Curr Opin Pediatr. 2009;21(4):505–10.PubMedCrossRefGoogle Scholar
  3. Letko E, Papaliodis DN, Papaliodis GN, et al. Steven–Johnson syndrome and toxic epidermal necrolysis: a review of literature. Ann Allergy Asthma Immunol. 2005;94:419–36.PubMedCrossRefGoogle Scholar
  4. Lissia M, Figus A, Rubino C. Intravenous immunoglobulins and plasmapheresis combined treatment in patients with severe toxic epidermal necrolysis: preliminary report. Br J Plast Surg. 2005;58:504–10.PubMedCrossRefGoogle Scholar
  5. Pereira FA, Mudgil AV, Rosmarin DM. Toxic epidermal necrolysis. J Am Acad Dermatol. 2007;56(2):181–200.PubMedCrossRefGoogle Scholar
  6. Stevens AM, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia: report of two cases in children. Am J Dis Child. 1922;24:526–33.CrossRefGoogle Scholar
  7. Worswick S, Cotliar J. Stevens–Johnson syndrome and toxic epidermal necrolysis: a review pf treatment options. Dermatol Ther. 2011;24(2):207–18.PubMedCrossRefGoogle Scholar

Copyright information

© European Academy of Paediatric Dentistry 2013

Authors and Affiliations

  • M. Cicciù
    • 1
    Email author
  • F. Chiera
    • 2
  • R. Gallizzi
    • 2
  • A. Cicciù
    • 2
  • C. D. Salpietro
    • 2
  1. 1.Human Pathology Department, Dental SchoolMessina UniversityMessinaItaly
  2. 2.Genetic and Immunology Paediatric DepartmentUniversity of MessinaPaediatric CentreItaly

Personalised recommendations