From the Guidelines
Herpes simplex virus (HSV) and Mycoplasma pneumoniae are the most commonly implicated viral and bacterial infections causing Steven Johnson Syndrome (SJS) in children, as reported in the British Association of Dermatologists' guidelines 1. The condition is characterized by an immune-mediated hypersensitivity reaction, resulting in severe mucocutaneous blistering and detachment of the epidermis. Key considerations in the management of SJS include:
- Immediate discontinuation of suspected triggers, such as medications or infections
- Supportive care to manage symptoms and prevent complications
- Referral to a specialist center for diagnostic testing and guidance on management, particularly in severe cases or when the causal agent is unclear
- Consideration of genetic predisposition, such as HLA typing, in certain populations before initiating treatment with high-risk medications like carbamazepine 1. Infections, including HSV and Mycoplasma pneumoniae, are common causes of SJS in the pediatric population, with up to 50% of cases attributed to infectious triggers 1. The clinical presentation of SJS typically includes fever, skin pain, and widespread erythematous or purplish macules that evolve into blisters, and prompt recognition and treatment are critical to reducing morbidity and mortality.
From the Research
Virus Associated with Stevens-Johnson Syndrome
- Herpes simplex virus has been implicated as a cause of Stevens-Johnson syndrome, as seen in a 36-year-old man with recurrent episodes of the condition 2.
- The use of acyclovir and prednisone has been shown to be effective in preventing the progression of herpes simplex virus infections to Stevens-Johnson syndrome 2, 3.
- Varicella infection has also been reported as a potential cause of Stevens-Johnson syndrome, with early and intense corticosteroid therapy potentially being lifesaving 4.
Management of Virus-Induced Stevens-Johnson Syndrome
- A management protocol involving immediate therapy with acyclovir and prednisone at the onset of herpes simplex virus oropharyngitis has been successful in preventing episodes of Stevens-Johnson syndrome 2.
- Continuous low-dose acyclovir with prompt institution of a regimen of prednisone and higher-dose acyclovir has also been effective in preventing the progression of recurrent herpes simplex virus stomatitis to Stevens-Johnson syndrome 3.
- Prophylactic acyclovir and therapy for exacerbations of herpetic lesions with acyclovir and prednisone have been shown to induce significant control of recurrent erythema multiforme secondary to herpes simplex 4.