Patient Expires Following Delayed Diagnosis Of Stevens-Johnson Syndrome

Case Overview

This case involves a 36-year-old male patient with a history of PTSD who went to the hospital for treatment of an anxiety attack. He was given medication and discharged within the day. He returned to the hospital one week later with a rash from head to toe. He was admitted and quarantined for suspicion of measles. The doctors later determined she had Stevens-Johnson Syndrome, but they did not arrive at this diagnosis for almost 4 days. The patient was then given a feeding tube. The patient was not given a rectal tube, however, and the patient proceeded to soil himself. For this, the patient was treated as if he had a burn: the nurses lubricated the patient’s skin and put silver patches on. The patient never recovered from the Stevens-Johnson Syndrome and eventually died. An expert in dermatology was sought to review the records and opine on whether an earlier diagnosis may have improved the patient’s prognosis.

Questions to the Dermatology expert and their responses

How often do you diagnose Stevens-Johnson Syndrome?

Luckily, Stevens-Johnson Syndrome is rare. I have personally cared for two patients with Stevens-Johnson Syndrome in the past 6 months. I take calls for 2 weeks every 2 months at the dermatology inpatient consultation service, which is where we typically see and treat Stevens-Johnson Syndrome.

What are some signs/symptoms that would differentiate Stevens-Johnson Syndrome from measles?

Measles is not on the list of differential possibilities with typical Stevens-Johnson Syndrome lesions. Maybe in the first few hours of the rash, an attending physician could possibly be confused, but not as the disease progresses beyond that. The rash is different. The mucous membrane lesions are different. The diseases are as different as cats are from dogs.

Can an early diagnosis of Stevens-Johnson Syndrome halt its progression? Please explain.

Based on clinical experience, the sooner Stevens-Johnson Syndrome is diagnosed, the better the outcome.

About the expert

This highly qualified dermatologist has 40 years of experience in his field. He received his BA in English and biology from Cornell University, before going on to obtain his MD from the State University of New York Upstate Medical School. This expert then completed an internship in internal medicine at the State University of New York Upstate University Hospital and a residency in dermatology at Stanford University, where he was named chief resident. Today, he is a fellow of the American Academy of Dermatology, and he is a member of several national and local professional organizations. This expert is also very active in academic, having published 11 peer-reviewed articles in his field. Formerly, he served as a clinical assistant professor of internal medicine at Southern Illinois University, as a clinical associate professor of family practice at Southern Illinois University, and as a dermatologist and clinical associate professor of dermatology at St. Louis University. Currently, this expert practices as a dermatologist at two regional medical centers in New Mexico and at a university-affiliated health network in Arizona. He is also a clinical associate professor of dermatology at a major university in Arizona.