Stevens-Johnson syndrome: the importance of family physician recognition

Abstract

Introduction: Children are often affected by infectious diseases, not only because their most vulnerable epidemiological context, but also from their immaturity immune system. The rash illnesses are common at this stage of life, imposing to the family physician a high diagnostic difficulty to skin diseases. The purpose of this report is relates the importance of the family physician recognize skin diseases more severe, to behave as dermatologic emergencies. Case description: Female child, five years old without a history of relief. In August 2015, she appealed to general practice by fever, malaise and with two erythematous and ulcerated lower lip injuries. This was seen as chickenpox. Two days later it was complicated by similar lesions on the vaginal mucosa, palpebral edema and bilateral ocular mucopurulent exudates. Because total food refusal, she turned to a private emergency service, where she was hospitalized. Given the lack of improvement, she was transferred to the hospital of her home area three days later, prostrate with multiple aphthous lesions on the oral and vaginal mucosa, dispersed subconjunctival hemorrhages and keratitis. She was admitted to the pediatric service. Given the clinical picture of ulcerative stomatitis, purulent conjunctivitis and vulvoganite, the clinical diagnosis of Stevens-Johnson syndrome was assumed. Comments: Stevens-Johnson syndrome is characterized by a delayed hypersensitivity skin reaction, which affects the skin and mucous membranes. It constitutes a dermatological emergency with high potential for morbidity and mortality, difficult to diagnose in clinical practice of the family physician. Family physician need to pay special attention to the skin lesions or mucous membranes which are associated with drugs, viral infections, cancer or just injuries that concern some degree of suspicion should not be delayed urgent hospital referral.