PMC6341237_01
Patient images. Physical examination showed conjunctival, mucosal, and skin involvement. Stevens-Johnson syndrome affects less than 30% of the body surface area and commonly affects mucous membranes. The photographs presented in Figure 2 were obtained with patient permission and depict the lesions throughout his body. (a) Involvement of the conjunctiva of the right eye. (b) Mucosal ulcers of the oropharynx. (c-f) Other areas of skin involvement that totaled to less than 30% of total body surface.
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Physical examination of the patient revealed a severe rash covering less than thirty percent of the body, oral ulcers, and conjunctival redness (Figure 1).
Biopsy images and pathology report. Microscopic examination of the skin (hematoxylin and eosin stain) was performed. The punch biopsies from the edges of both lesions (left forearm and left medial foot) show similar morphologic features. There is a predominantly normal intact stratum corneum overlying the epidermis. Within the dermis, there is interface dermatitis with a superficial perivascular infiltrate of lymphocytes with occasional neutrophils (a). Additionally, basal vacuolization with dyskeratotic keratinocytes scattered throughout all levels of the epidermis is seen. Mild interstitial and periadnexal lymphocytic inflammation are noted (b) as well as a focal area of neutrophils present in the keratin plug of a hair follicle (c). There is a focal area of incipient epidermal detachment present (d). No fungal elements or eosinophilic infiltration are noted in the specimens. The histologic features are consistent with toxic epidermal necrolysis/Stevens-Johnson syndrome.
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Light microscopy of the hematoxylin and eosin-stained specimens were confirmatory for SJS (Figure 2).