Steven Johnson Syndrome (SJS) is a severe and life-threatening condition that is more prone to anybody who is considered immunocompromised. One such state of being immunocompromised is pregnancy. SJS is a hypersensitivity reaction to certain drugs and vaccines affecting the skin and the mucous membranes. What happens is that in the body there is altered drug metabolism in some patients causing formation of reactive metabolites that bind to and alter cell proteins. This triggers a T-cell-mediated cytotoxic reaction to drug antigens in keratinocytes.

SJS skin lesions and sores can affect the mucous membranes of eyes, mouth, nasal passage, lips and genitals. Hence, this is extremely dangerous, and thankfully, rare in pregnancy. The reason why this condition has to be monitored with care is that severe constitutional disturbances can result in death from pneumonia, septicemia, myocarditis or renal failure. All of these can be fatal for the mother and the fetus. Also, severe scarring of the genital tract may also occur occasionally, with no permanent damage to the female genital tract itself.

Through much research, one case report of vaginal stenosis after SJS in pregnancy was discovered 6 weeks after cesarean section for breech presentation. In this case study, the good news was the baby being born in perfect health. The management of SJS was similar in pregnancy as it would be for any other affected patient. Immediately after the diagnosis was made, the medical team promptly withdrew all potential causative drugs and began intravenous fluid replacement. During the time the mother was in the ICU, symptomatic treatment was done with care, oral nutrition was initiated by nasogastric tube, anticoagulation and the prevention of stress ulcer begun.

The treatment included topical antiseptics (0.5% silver nitrate or 0.05% chlorhexidine) paint, bathe, or dress the patients. Though it is difficult to have advised preventive measures for SJS, the patient was informed of the likelihood of recurrence, and to avoid all drugs with SJS as a potential side effect. With early diagnosis and prompt management, in this case, the mother and the child were both saved. Specifically, in the case study, the patient was taking injectable Cefotaxime and after four days she had redness of the eyes, swelling of the lips, iris lesions which were becoming congruent all over the body, on the palms, soles, oral ulcers and was unable to take anything orally.

When she was admitted she had a rash that involved the palms and soles, and her mouth was edematous. There were ragged ulcers on her buccal mucosa that spread all over her lips and soft palate. Fortunately for the patient, she was past 37 weeks gestation, because, on her second day of hospitalization, she had premature rupture of membranes (PROM) and delivered a female child vaginally. Throughout labor, there were no issues, but after delivery, she began to form new lesions and was put on systemic steroids. After ten days, she was tapered off and the mom and baby were discharged home.

If you or a loved one have been diagnosed with SJS and have any concerns or would like to file a suit for medical negligence, contact us today.