Case Number : Case 2764 - 9 February 2021 Posted By: Uma Sundram

Stevens Johnson Syndrome

Agree with Stevens Johnson syndrome.

SJS or TEN

2 hours ago, Meenakshi Batrani said:

SJS or TEN

I think I would go for TEN in view of the description of "full body desquamative rash".

TEN.

Pigment incontinence suggests it's a little longer standing than is typical for EM / SJS. I note some colloid bodies in clusters and a hint of acantholysis. How about paraneoplastic pemphigus in addition to the suggestions above.

2 hours ago, Dr. Richard Carr said:

Pigment incontinence suggests it's a little longer standing than is typical for EM / SJS. I note some colloid bodies in clusters and a hint of acantholysis. How about paraneoplastic pemphigus in addition to the suggestions above.

There is a predominantly acantholytic pattern of injury, with eccrine duct involvement resembling post chemotherapeutic changes. Also there is pigment incontinence, as R.C. said. I’m not familiar with Paraneoplastic Pemphigus, but I’ll take this diagnosis over EM/SJS/TEN. 

Well spotted and explained by Dr Carr. Favour pemphigus as well and further information is needed such as DIF/transitional epithelium immunofluorescence results to clarify if PNP or not. 

It's early yet, but both Pemphigus and SJS/TEN were suggested. Waiting for additional biopsies for r/o Pemphigus.

EM

On 11/02/2021 at 21:14, Uma Sundram said:

It's early yet, but both Pemphigus and SJS/TEN were suggested. Waiting for additional biopsies for r/o Pemphigus.

Can you let us know the outcome of further biopsies please?

We don't have any further follow up. I believe the patient was transferred to another hospital but no other biopsies came our way.