Early Stevens-Johnson Syndrome Mimicking Secondary Syphilis: A Case Report
Keywords:
Stevens-Johnson syndrome, toxic epidermal necrolysis, syphilis, vesicobullous lesionAbstract
Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare life-threatening vesicobullous condition caused by immunologic reactions to several stimuli, usually a reaction to certain medications. A 21-year-old Indonesian male adult came to the emergency department with chief complaints of painful erythematous rashes on his hands and feet, watery eyes, and sore throat. He is also been diagnosed with bipolar disorder and currently still on medication. His rash worsened during initial hospitalization and was given appropriate treatment. Stevens-Johnson syndrome is known to be presented as a systemic mucocutaneous lesions with organ involvement. Syphilis is highly infectious sexually transmitted infection and known as "the great imitator" as it often presents as other chronic dermatoses, leading to a difficult and delayed diagnosis. The skin is involved in 70% of cases, with maculopapular, vesiculobullous, and ulcerative morphologies possible at presentation, making the diagnosis of secondary syphilis challenging given its ability to mimic many other conditions. This case emphasizes the importance of pattern recognition of Stevens-Johnson syndrome, as this is a rare but serious condition.References
Wirya A, Suga H, Kurniadi I, Miyagaki T, Miyazaki M, Sato S. A case of secondary syphilis manifesting erythema multiforme-like skin lesions. Dermatologica Sin. 2019;37(3):172–3.
Dutt J, Sapra A, Sheth-Dutt P, Bhandari P, Gupta S. Stevens-Johnson Syndrome: a perplexing diagnosis. Cureus. 2020;12(3).
Cook OM, Knafo J, Bhaskar R, Salhab M, Nguyen H. Secondary syphilis presenting as erythema multiforme in the setting of AIDS and psoriasis. Cureus. 2022;14(9).
H Kawi N, Sihotang EP, Nisa T, Hui B, Causer LM, Januraga PP, et al. Incidence and risk factors for syphilis infection among men who have sex with men: a cohort study from an urban sexual health clinic in Jakarta, Indonesia. Int J STD AIDS. 2022;33(12):1065–72.
Cherneskie T, Bachmann L, Blank S, Bolan G, Daskalakis DC, Lee E, et al. The diagnosis , management and prevention of syphilis: an update and review. In: Millstone M, Selkowe E, Stevens LM, editors. New York: The New York City Department of Health and Mental Hygiene Bureau of Sexually Transmitted Infections and The New York City STD Prevention Training Center. 2019;5–6.
Çakmak SK, Tamer E, Karadağ AS, Waugh M. Syphilis: a great imitator. Clin Dermatol. 2019;37(3):182–91.
Zimmerman D, Dang NH. Stevens–Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). In: Nates JL, Price KJ, editors. Oncologic Critical Care. Springer Nature Switzerland AG. 2020;267–80.
Chang WC, Abe R, Anderson P, Anderson W, Ardern-Jones MR, Beachkofsky TM, et al. SJS/TEN 2019: from science to translation. J Dermatol Sci. 2020;98(1):2–12.
Besag FMC, Vasey MJ, Sharma AN, Lam ICH. Efficacy and safety of lamotrigine in the treatment of bipolar disorder across the lifespan: a systematic review. Ther Adv Psychopharmacol. 2021;11:1-37.
Tsukagoshi E, Tanaka Y, Saito Y. Implementation of Pharmacogenomic Information on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Front Med. 2021;8.
Jha KK, Chaudhary DP, Rijal T, Dahal S. Delayed Stevens-Johnson syndrome secondary to the use of lamotrigine in bipolar mood disorder. Indian J Psychol Med. 2017;39(2):209–12.