PMC5859217_01
Multiple reddish macules, patches and tense bullae with atypical target lesions over the face, neck, trunk and limbs of patient. Written informed consent was obtained from the mother of the patient for publication.
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F1
On day 3 after finishing vancomycin treatment, multiple and progressive target-like macules and papules developed across the patient's lower trunk and limbs, and then extended to his forehead, lips, whole trunk, and extremities (Figure 1). The rashes gave way to skin desquamation, at which point the patient was discharged (Figure S1 in Supplementary Material).
Detection of serum granulysin by the granulysin rapid test. (A) Serum taken from the SJS patient at the time of blister formation. (B) Recombinant human granulysin as positive control. (C) Normal human serum as negative control. The method of results interpretation is according to Fujita et al..
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F2
In our case, the granulysin level in serum revealed a positive result consistent with an attack of SJS (Figure 2).
Skin biopsy of patient in H&E staining. (A) Subepidermal vesicles were accompanied by apoptotic keratinocytes presenting individually and in clusters within the epidermis in 10 power view. Lymphocytic infiltrations were observed scattered in the basal layer of the epidermis and around the vessels within the dermis. (B) Perivascular infiltrate composed primarily of lymphocytes in 20 power view.
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F3
The patients's skin biopsy later revealed typical pathologic findings of SJS, including subepidermal vesicles containing apoptotic keratinocytes and perivascular lymphocytic infiltration (Figure 3).