[CIS PIDD] [cis-pidd] VS: 13 y/o female with SJS secondary to mycoplasma

[Seppänen Mikko]

Dear Sara,

In addition to the paths suggested by Dewton and prof Atkinson (agree):

I would carefully ask for any flu medications, NSAIDs a.s.f. the patient received before SJS appeared (including those with a little delay, is essentially a form of delayed hypersensitivity) and would advice against the use of those in upcoming respiratory infections (though I believe You have already done so). In clinical practice, many of the patients with erythema multiforme and SJS at least seem to have a combination of a specific infection and  a specific drug when recurring, though this might not be formally proven? Since many of the drugs for colds are easily avoidable, would not hurt either...

BTW: in recurrent EM/SJS, HSV is most often the culprit and its genome has also been shown directly from the lesions, trigger might however been clinically evident up to appr. 3 weeks previously.

Mikko
__________________________________________________
Mikko Seppänen, MD, PhD, Docent (Associate professor/Senior Lecturer)
Specialist in Internal Medicine and Infectious Diseases
Senior Consultant, Physician in charge (PIDD)
EM(E)A Expert, PIDDs and Intravenous Immunoglobulin Therapy

Immunodeficiency Unit
Division of Infectious Diseases
Department of Medicine
Helsinki University Central Hospital
Hospital District of Helsinki and Uusimaa
Aurora Hospital, Ward 4-2 and Outpatient Clinic
P.O.Box 348
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FINLAND
phone +358 9 47175923, fax +358 9 47175945
_________________________________________



Lähettäjä: Anvari, Sara, [mailto:sanvari at cmh.edu]
Lähetetty: 16. tammikuuta 2014 17:51
Vastaanottaja: CIS-PIDD
Aihe: [cis-pidd] 13 y/o female with SJS secondary to mycoplasma

Dear all,

Wondering if someone out there might have had experience with a case similar to this (see below) and could offer us some additional direction...

We have a 13 y/o female patient who was recently admitted for Stevens Johnson Syndrome that was triggered by a Mycoplasma pneumoniae infection. The patient's past medical history is only significant for an episode of hemolytic uremic syndrome at 4 years of age, otherwise no history of any underlying medical conditions.

The parent was concerned about her daughter's risk of recurrence and was wanted to know if there was a test to identify if she were at higher risk for recurrence of SJS with mycoplasma and if there was anything the patient could take prophylactically to help prevent a recurrence. At this time, we know there is some risk of recurrence of SJS with mycoplasma and we were wondering if anyone may have had a case similar to this and if they could share their insight and experiences with us.

We greatly appreciate any help or insights anyone can offer.

Best regards,

Sara



Sara Anvari, MD
Fellow
Division of Allergy/Asthma/Immunology
Children's Mercy Hospital and Clinics
2401 Gillham Road
Kansas City, MO 64108
Phone: (816) 960-8885
Fax: (816) 960-8888


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