The Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum: A Report of Two Contrasting Cases Managed in a Burn Unit.
- 1"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania.
- 2Department of Plastic Surgery and Reconstructive Microsurgery, Sf. Spiridon Emergency County Hospital, 700111 Iasi, Romania.
- 3Cardiology Clinic, Sf Spiridon Emergency County Hospital, 700111 Iasi, Romania.
Abstract
Background
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, potentially life-threatening mucocutaneous reactions classified based on body surface area (BSA) involvement: SJS affects less than 10% BSA, SJS/TEN overlap affects 10-30% BSA, and TEN affects more than 30% BSA. The mortality rates range from 4.8-9% for SJS to 14.8-48% for TEN. Treatment remains controversial, with corticosteroids and intravenous immunoglobulin (IVIg) being the most debated therapeutic options. While some studies suggest IVIg may block Fas-mediated keratinocyte apoptosis, meta-analyses have shown conflicting results regarding mortality benefit.Case presentation
We describe two patients from opposite ends of the SJS/TEN spectrum, managed in a burn unit with different therapeutic approaches. The first patient, a 47-year-old man with systemic lupus erythematosus, developed TEN with approximately 35% body surface area involvement, complicated by sepsis and rhabdomyolysis; he was treated with systemic corticosteroids and intravenous immunoglobulin (IVIg, 0.4 g/kg/day for 3 days). The second patient, a 66-year-old woman, developed SJS attributed to amoxicillin-clavulanic acid and was treated with systemic corticosteroids alone. Both patients achieved complete re-epithelialization without major sequelae.Conclusions
These two cases illustrate the clinical heterogeneity of the SJS/TEN spectrum and the central role of early recognition, prompt withdrawal of the culprit drug, transfer to a specialized unit, and multidisciplinary supportive care. Given the substantial differences between the two patients in age, sex, comorbidities, culprit drugs, and disease severity, no comparative or causal inference regarding the relative efficacy of the two treatment strategies can be drawn; no efficacy claim is made for either therapeutic approach; this report is descriptive, and the two cases are presented as contrasting rather than comparable.
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BibTeX
@article{constantinescu2026stevensjohnson,
title = {{The Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum: A Report of Two Contrasting Cases Managed in a Burn Unit.}},
author = {Mihai-Codrin Constantinescu and Dan-Cristian Moraru and Vladimir Poroch and Stefana Avadanei-Luca and Andrei-Nicolae Gologan and Alexandru-Hristo Amarandei and Awad Dmour and Dragos-Florin Gheuca-Solovastru and Bianca-Ana Dmour and Delia-Gabriela Ciobanu-Apostol and Mihaela Pertea},
journal = {Diseases (Basel, Switzerland)},
year = {2026},
month = sep,
doi = {10.3390/diseases14100355},
url = {https://europepmc.org/article/MED/42929981},
note = {CC BY},
}
RIS
TY - JOUR
TI - The Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Spectrum: A Report of Two Contrasting Cases Managed in a Burn Unit.
AU - Mihai-Codrin Constantinescu
AU - Dan-Cristian Moraru
AU - Vladimir Poroch
AU - Stefana Avadanei-Luca
AU - Andrei-Nicolae Gologan
AU - Alexandru-Hristo Amarandei
AU - Awad Dmour
AU - Dragos-Florin Gheuca-Solovastru
AU - Bianca-Ana Dmour
AU - Delia-Gabriela Ciobanu-Apostol
AU - Mihaela Pertea
PY - 2026
DA - 2026/09/25
JO - Diseases (Basel, Switzerland)
DO - 10.3390/diseases14100355
UR - https://europepmc.org/article/MED/42929981
AB - Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, potentially life-threatening mucocutaneous reactions classified based on body surface area (BSA) involvement: SJS affects less than 10% BSA, SJS/TEN overlap affects 10-30% BSA, and TEN affects more than 30% BSA. The mortality rates range from 4.8-9% for SJS to 14.8-48% for TEN. Treatment remains controversial, with corticosteroids and intravenous immunoglobulin (IVIg) being the most debated therapeutic options. While some studies suggest IVIg may block Fas-mediated keratinocyte apoptosis, meta-analyses have shown conflicting results regarding mortality benefit.Case presentation We describe two patients from opposite ends of the SJS/TEN spectrum, managed in a burn unit with different therapeutic approaches. The first patient, a 47-year-old man with systemic lupus erythematosus, developed TEN with approximately 35% body surface area involvement, complicated by sepsis and rhabdomyolysis; he was treated with systemic corticosteroids and intravenous immunoglobulin (IVIg, 0.4 g/kg/day for 3 days). The second patient, a 66-year-old woman, developed SJS attributed to amoxicillin-clavulanic acid and was treated with systemic corticosteroids alone. Both patients achieved complete re-epithelialization without major sequelae.Conclusions These two cases illustrate the clinical heterogeneity of the SJS/TEN spectrum and the central role of early recognition, prompt withdrawal of the culprit drug, transfer to a specialized unit, and multidisciplinary supportive care. Given the substantial differences between the two patients in age, sex, comorbidities, culprit drugs, and disease severity, no comparative or causal inference regarding the relative efficacy of the two treatment strategies can be drawn; no efficacy claim is made for either therapeutic approach; this report is descriptive, and the two cases are presented as contrasting rather than comparable.
SN - 2079-9721
ER -