ABSTRACT
BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and potentially life-threatening mucocutaneous reactions. Given their rarity, limited cohort studies have been done. The aim of this study is to evaluate and compare the demographics, etiology, management, clinical and laboratory characteristics, complications, and outcome of SJS/TEN patients seen by the inpatient dermatology service at the University of Puerto Rico. METHODS: A retrospective review of 30 cases with identified diagnosis of SJS, overlap SJS/TEN, or TEN who were consulted to the Dermatology Department of the University of Puerto Rico from 2006 to 2017. RESULTS: A total of 24 adult and six pediatric cases were reviewed. Females were predominant with a female to male ratio of 1.3 : 1. The most frequent offending drugs identified were antibiotics (56.7%), anticonvulsants (23.3%), and nonsteroidal anti-inflammatory drugs (NSAIDs) (16.7%) with the most frequent antibiotic identified being trimethoprim/sulfamethoxazole (23.3%). Seventy percent of patients experienced at least one complication, most often of infectious etiology (80.1%). During hospital course, 73% received pharmacologic therapy (23% received IVIG alone, 17% received steroids alone, and 33% both) versus 27% which received only supportive care. Mortality rate in this study was 13.8%. When comparing SCORTEN at day one of admission, deceased cases had a mean SCORTEN at day 1 of 4.0, while survivors had an average of 1.54 (P < 0.001). CONCLUSION: Antibiotics followed by anticonvulsants were the most frequently offending drugs identified within this study.
Subject(s)
Anti-Bacterial Agents/adverse effects , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Anticonvulsants/adverse effects , Stevens-Johnson Syndrome/etiology , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Hospital Mortality , Humans , Immunoglobulins, Intravenous/therapeutic use , Male , Middle Aged , Palliative Care/methods , Puerto Rico , Retrospective Studies , Risk Assessment , Severity of Illness Index , Stevens-Johnson Syndrome/diagnosis , Stevens-Johnson Syndrome/mortality , Stevens-Johnson Syndrome/therapy , Young AdultABSTRACT
OBJECTIVE: To characterize and analyze the inpatient and emergency pediatric dermatology consults in our academic hospital center. METHODS: We reviewed 485 consultations that were done by the University of Puerto Rico Department of Dermatology from July 2007 to June 2012. The date, patient age and gender, consulting service, presumptive diagnosis, final diagnosis, and diagnostic procedures performed were documented for each consult. RESULTS: The patients' ages ranged from newborn to 18 years; the 13 to 18 years age group was the most common (29%). Dermatology consults were requested by the general pediatrics ward, primarily (32%), followed by the emergency room (25%). In 236 cases (48.6%), a vague diagnostic impression was provided by the consulting service, whereas in 249 (51.4%) cases, a specific or differential diagnosis was provided. The dermatology service changed the diagnosis in 12% (58/249) of the evaluated cases. The most common misdiagnoses were allergic contact dermatitis, drug eruption, papular urticaria, nutritional deficiency, atopic dermatitis, seborrheic dermatitis, cellulitis, and herpes infection. The most common diagnoses encountered were inflammatory skin conditions, infectious diseases, and drug eruptions. Skin biopsy was the most common procedure performed. In 30% of the cases, more than 1 procedure was performed as part of the evaluation work-up. CONCLUSION: Our study demonstrates the important role of the dermatologist in the diagnosis and management of pediatric patients with dermatological diseases. The information contained within this manuscript should contribute to raising the awareness of pediatricians regarding the most common dermatological diagnoses in this patient population.
Subject(s)
Dermatologists/organization & administration , Dermatology/statistics & numerical data , Emergency Service, Hospital/statistics & numerical data , Skin Diseases/epidemiology , Academic Medical Centers , Adolescent , Biopsy , Child , Child, Preschool , Diagnosis, Differential , Diagnostic Errors/statistics & numerical data , Female , Humans , Infant , Infant, Newborn , Inpatients , Male , Physician's Role , Puerto Rico , Retrospective Studies , Skin Diseases/diagnosis , Skin Diseases/physiopathologyABSTRACT
Leukemia cutis describes the infiltration and dissemination of neoplastic leukemic cells into the epidermis, dermis, or subcutis, resulting in clinically identifiable cutaneous lesions. Depending on the type of leukemia, a wide range of clinical and histopathological findings may be encountered. This report describes a patient with a rosacea-like eruption as a unique clinical presentation of T-cell prolymphocytic leukemia.
