This case study involves an adult male with bipolar disorder who was incarcerated in a state prison. He was prescribed carbamazepine and lamotrigine as part of his treatment plan.
Over time, he developed symptoms such as a sore throat, muscle aches, fever, and chest rash. Despite these alarming signs, the initial diagnosis was a viral rash.
In response to his worsening condition, which included eye pain and dehydration, the patient’s care was escalated. It wasn’t until he was transferred to an emergency room that he was correctly diagnosed with Stevens-Johnson Syndrome.
Consequently, the patient suffered extensive burns covering most of his body, permanent scarring, and ocular impairment that required bilateral amniotic membrane transplantation.
Questions to the Correctional Medicine expert and their responses
How often do you evaluate and manage patients who present to a prison infirmary/clinic with fever and rash?
In my role as Chief Medical Officer/Chief Physician Executive at a major correctional facility hospital, I frequently encounter patients presenting with symptoms such as fever and rash.
What are the most pertinent measures for correctional medicine providers to perform to promptly diagnose and effectively manage Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN)?
The key measures that can be taken by a correctional medicine provider to promptly manage patients on the SJS/TEN spectrum are prompt recognition of the condition; immediate discontinuation of the offending drug; and swift escalation of care to a burn center intensive care unit, as this is the only measure that has been proven unequivocally to reduce mortality rates and improve outcomes for patients diagnosed with SJS/TEN.
How does intervention timeline affect patient outcomes in SJS/TEN?
Timeliness of intervention is crucial in SJS/TEN cases. Patients must promptly be transferred to a higher level of care, ideally an intensive care burn center unit, as soon as possible after discontinuation of the offending agent.
About the expert
This expert has an extensive 20-year background in internal medicine and correctional medicine, with board certifications in both fields. They have served in various correctional medicine roles since 2006, including as the chief medical officer at a corrections agency and the medical director at multiple correctional care agencies. Currently, they hold an associate professorship of internal medicine at a Texas university, demonstrating their ongoing commitment to academic excellence and practical application in their field.