The document presents a case study of a 23-year-old female diagnosed with Steven Johnson Syndrome (SJS), a rare and serious condition typically triggered by medication or infections, marked by severe skin and mucous membrane reactions. It details her symptoms, medications, vital signs, laboratory results, and the treatment plan aimed at relieving her symptoms and preventing complications. Key medications administered include immunosuppressants, antibiotics, and anti-fungal treatments, alongside patient counseling for recovery support.

1. By :- Teena
1412818
Pharm.D 4th yr
Case Presentation
On
STEVEN JOHONSON
SYNDROME

2. SJS
Rare but serious disorder of skin & mucous membrane.
Most often, it's a severe reaction to a medicine. SJS
is thought to arise from a disorder of the immune
system.
SYMPTOMS
 begins with fever, sore
throat, and fatigue,
 Painful red or purple skin
 Blisters on your
skin, mouth, nose, and
genitals
 Red, painful, watery eyes

3. CAUSES
 Medicines for gout, especially allopurinol
 Pain relievers such as acetaminophen, ibuprofen, and
naproxen sodium .
 Sulfa antibiotics
 Medicines that treat seizures carbamazepine.
Infections that can cause Stevens-Johnson syndrome
include:
 Herpes (herpes simplex or herpes zoster)
 Pneumonia
 HIV
 Hepatitis

4. Case Description
 A 23yr old Female admitted to MMIMSR hospital on 06.08.2015 with the
C/O
 Rashes over whole body except legs *2 days
 Vomiting *1 day
 Fever *1 day
 Painful swallowing
O/E
 Multiple ulcers present over lips & oral cavity
 Macular rashes present over face, neck, abdomen & upper
limbs
 Odynophagia
 Difficulty in speech

5.  Past medical history : Epilepsy (7YRS back )
pt. has earlier developed SJS in 2010 due to
carbamazipine
 Past medication history:
 Mirtazapine {50mg}
 Clonazepam {0.5mg}
 Propanolol
 Lorazepam
 also took ayurvedic medicines
 Family and Social History: non smoker, no
addiction , vegetarian, sleep & appetite decrease

6. Physical Investigations

7. Vitals 6/8 7/8 8/8 9/8 10/8 11/8 12/8 13/8
BP(mm/
Hg)
112/76 122/78 90/60 130/90 88/54 120/80 100/60 110/90
Pulse
Rate
(/min)
88 86 96 100 88 96 84 120
Resp
Rate
(/min)
18 20 16 18 16 18 18 18
Temp (F) Afeb. Afeb. 102⁰ Afeb. Afeb. Afeb. Afeb. Afeb

8. Vitals 14/8 15/8 16/8 17/8 18/8 19/8 20/8
BP(mm
/Hg)
110/60 110/90 102/60 108/70 90/70 90/70 110/70
Pulse
Rate
(/min)
84 80 88 84 88 86 86
Resp
Rate
(/min)
16 16 16 16 18 16 16
Temp
(F)
Afeb. Afeb. Afeb. Afeb. Afeb. Afeb. Afeb.

9. Laboratory Investigations

10. Constituents Normal Range 7/8 11/8 18/8
DLC
Polymorphs
40 – 75% *80 71 *78
Lymphocytes 20 – 40% *17 25 *19
Eosinophils 02 – 6% 03 03 03
Monocytes 02 – 10% *00 01 *00
Basophils 00 – 1% 00 00 00
ESR 0-20mm/1st hr *22 *70 *35
HB 12 – 15gm % 10.4 10.6 11
Platelet count 1.5 – 4.5 lac/ cumm *1.4 2.0
TLC 4000 – 10000/cumm 9800 1300

11. Constituents Normal Range 7/8 18/8
LFT
BilirubinTotal
0.20 – 1.00 mg/dl 0.77
Bilirubin Direct 0.10 – 0.30 mg/dl 0.34
SGOT 5 – 40 IU/L *74
SGPT 5 – 35 IU/L *123
Alkaline
Phosphatase
5 – 112 IU/L *217
RFT
Urea
15 – 40 mg/dl 20 18
Creatinine 0.40 – 1.40 mg/dl 1.1 0.89
Sodium 135 – 145 mEq/L 132 132
Chloride 96 – 106 mmol/L 98 107
Potassium 3.50 – 5.00 mEq/L 3.7 3.9

12. URINE CULTURE
7/8 11/8 18/8
VOLUME 20ml 20ml 40ml
COLOR Pale yellow Pale yellow Pale yellow
U. ALBUMIN ++ Traces NIL
U. SUGAR
FASTING
NIL NIL NIL
PUS CELL 10-12 HPF 4-5 2-3 HPF
EPITHELIAL CELL 6-8 HPF 2-3 HPF 2-3 HPF
CAST & CRYSTALS NIL NIL NIL

13. Specific Test
 USG Abdomen
 Impression : normal
 HbsAg : Negative
 HCVTridot : Negative
 Malarial parasite : Negative

14. SOAP Note

15. SUBJECTIVE
 Patient came with complaints of
 Rashes over whole body except legs
*2 days
 Vomiting *1 day
 Fever *1 day
 Painful swallowing

16. OBJECTIVE
 To correct the abnormal values of :-
 Monocytes
 Polymorphs
 Lymphocytes
 ESR
 SGPT
 Alk. phosphatase
 Urine albumin

17. ASSESSMENT/ FINAL DIAGNOSIS
 The patient on basis of subjective and objective
information was diagnosed with
STEVEN JOHNSON SYNDROME
(SJS)

18. PLAN
 SHORTTERM GOALS
 Relieve symptoms.
 Make pt. take orally
food
 LONGTERM GOALS
 Delaying or halting the
progression of SJS
 Controlling the
disease from getting
more complicated.
 Also controlling the
epilepsy disease

20. DRUGS + API Dose +
Route
Date
of
Start
Date
of
Stop
Category Frequ
ency
Tab. Dexanil
(escitalopram)
10mg
oral
7/8 10/8 selective sertonin
reuptake inhibitors
OD
Tab.Mirtazapine 7.5mg
Oral
7/8 -- noradrenergic and
specific serotonergic
antidepressant
( NaSSA) & tetracyclic
antidepressants
HS
Cap.Cyclosporin 50mg
Oral
7/8 20/8 immunosuppressants OD
Betadine gargles
( povidone-
iodine)
Oral 7/8 20/8 Oral Antiseptic
Solution
QID

21. DRUGS + API Dose +
Route
Date
of
Start
Date
of
Stop
Category Frequen
cy
Candid mouth
wash
(clotrimazole)
Oral 7/8 20/8 anti-fungal oral
medication
QID
Inj .Ceftriaxone 1 g
IV
8/8 20/8 Antibiotic OD
Tab. Dolo
( PCM)
650mg
Oral
8/8 8/8 Anti pyretic +
Anlagesic
BD
Eye dropTear Plus 9/8 20/8 Lubricant BD
Tab. Linezolid 600 mg
oral
10/8 20/8 oxazolidinone
antibiotic
BD
Inj Decca
(NANDROLONE
DECANOATE )
1st day 2cc
followed by
1 cc
10/8 14/8 anabolic steroids OD

22. DRUGS +
API
Dose +
Route
Date
of
Start
Date
of
Stop
Category Frequ
ency
Tab.
Cyclosporin
100 mg
Oral
11/8 20/8 Immuno
suppressants
OD
Tab Instazine
(cetirizine)
11/8 - Anti histaminic &
Anti allergic
SOS
KMnO₄ topical
solution
10/8 20/8 disinfectant,
deodorising and
astringent
BD

23. Patient Counselling
 Adhere to the medication
 Periodic checkup.
 Take adequate rest .
 Take adequate fluids and nutrients as your body
needs to stay hydrated, and your skin needs
protein to rebuild.
 Maintain hygiene . Clean your wounds regularly.
 Take care of your eyes.