Retrospective Analysis of Upper Aerodigestive Manifestations of Stevens-Johnson Syndrome
Matthew Yii1, Michelle Truong1, Antonia Rowson1, Chrisdan Gan1, Howard Webb1, Jessica Prasad1, 1Alfred Health, Melbourne, VIC, Australia
Abstract
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) exist on a spectrum of mucocutaneous adverse reactions resulting from severe epidermolysis (Fakoya et al. 2018). Otolaryngology consultation is often sought to assess the extent of upper aerodigestive involvement. We aim to determine the anatomical patterns of upper aerodigestive involvement in SJS/TEN, and the effect of these patterns on acute clinical outcomes.
A retrospective analysis was performed of patients identified via audit data over ten-years at a state-wide Burns referral centre. A histologic diagnosis of SJS/TEN and flexible nasendoscope examination during admission was required for inclusion. Nasendoscope findings were analysed against presentation and clinical progression.
Fifty-four patients were identified via audit data to have SJS/TEN and underwent flexible nasendoscopy. The median age was 57.5 years (IQR 33.5 – 68.25). 45 patients (83.3%) were found to have any form of upper aerodigestive tract involvement. Oral cavity or lip involvement was present in 41 cases (75.9%); Nasal cavity or nasopharynx involvement was in 16 cases (29.6%); Oropharyngeal involvement was in 16 cases (29.6%); Laryngeal involvement was in 17 cases (31.5%), with epiglottic (24.1%) and arytenoid (24.1%) subsites most commonly implicated.
A multidisciplinary approach is critical when managing SJS/TEN. Nasendoscopy may identify patients at risk of upper airway compromise.
References:
1. Fakoya, A.O.J., Omenyi, P., Anthony, P., Anthony, F., Etti, P., Otohinoyi, D.A. and Olunu, E., 2018. Stevens-Johnson syndrome and toxic epidermal necrolysis; extensive review of reports of drug-induced etiologies, and possible therapeutic modalities. Open access Macedonian journal of medical sciences, 6(4), p.730.
Biography
Matthew Yii is a current ENT unaccredited registrar at Peninsula Health and previous surgical resident and intern at Alfred Health. He graduated from Monash University in 2019.