stevens johnson syndrome(8)
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Dr.Andri Catur Jatmiko,SpKK
BAG/SMF. ILMU KESEHATA KULIT DA KELAMI
!SU. Jom"an#Jom"an#
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SJS k$#a%atdaruratan ku&it d$n#an
#$'a&a (i(t$mik, ku&it dan muko(a ($rtadapat m$n)$ran# or#an &ain.
*$n)$"a" utamaa&$r#i o"at+- An#ka k$'adian 012/'uta/ta3un di $ropa
dan am$rika, di Indon$(ia ($kitar 04pa(i$n /ta3un, 55 d$%a(a,pria6%anita7460
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Suatu k$&ainan mukokutan$u( akut aki"at r$ak(i3ip$r($n(iti8ita( d$n#an #$'a&a k&ini( pada ku&it"$r8aria(i dari maku&a $rit$ma, papu&a, 8$(ik$&dan "u&a di($rtai &$(i )an# m$n#$nai dua atau
&$"i3 muko(a +ora&,kon'un#ti8a,ano#$nita& dandapat m$n)$ran# or#an &ain di($rtai #$'a&a(i(t$mik.
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Eropa dan Am$rika S$rikat01
2/'uta/ta3un
Indon$(ia04 pa(i$n/ta3un
55 d$%a(a
*ria 6 %anita 7460
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A&$r#i o"at +- (u&9onamid, antikon8u&(an,
SAID #o&on#an ok(ikam dan dik&o9$nak,a&&opurino&, &amotri#in ,n$8irapin$, p$ni(i&in,:uino&on, t$tra(ik&in, kortiko(t$roid.
In9$k(i, #ra9t 8$r(u( 3o(t di($a($, radia(i,8ak(ina(i, n$op&a(ma
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B$r3u"un#an d$n#an 3ip$r($n(iti;ta( tip$ 4
!$ak(i CD< m$n)$ran# k$ratino(it )an#"$rikatan d$n#an m$ta"o&it o"at induk(i
apopto(i(
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L$(i Ku&itma=u&a $rit$matou(, purpura, 8$(ik$&,
"ata( tidak '$&a(, "$r#a"un# ($=ara =$pat,Tar#$t &$(i )an# tidak (p$(i;k "$r%arna #$&apdit$n#a3n)a, iko&(k) (i#n/$pid$rmo&i(i(
t$r"ata( > 0- BSA
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a. Kelainan kulit
Makulaeritematosa spt
morbiliform rash,
vesikel, bula.
Vesikel & bula
pecaherosi
Prognosis buruk
bila purpura (+)
dan lesi
generalisata
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L$(i muko(a
=a8um ori( $ro(id$n#an p$rdara3an)an#n)$ri,p($udom$m"ranputi3 a"u1a"u
kru(ta k$3itamanpada "i"ir
Kon'un#ti8a 3ip$r$mi, $ro(i,k$mo(i(, 9oto9o"ia dan&akrima(i
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b. Kelainan mukosa orifisium
!avum oris ("##$), orifisium
genital eksterna(%#$), cavumnasi ($) dan anus ('$)
esi aal
Vesikel mukosa bibir, lidah,buccalpecaherosi,
ekskoriasi, eksudasi, ulserasi,
krusta hemoragik *kehitaman,
tebal, hipersalivasi
kesulitan menelan.
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G$'a&a (i(t$mik tidak (p$(i;k +d$mam,
3$ada=3$, r3initi(, m)aia, n)$ri t$&an,ra(a t$r"akar pada mata
G$'a&a mu&tior#an *u&mona& ($(ak, 3ip$r($kr$(i "ronku( dan
3ipok($mia
GITdiar$ )an# "$rat, m$&$na, p$r9ora(i ko&on
Traktu( urinariu( prot$inuri, mikroa&"uminuria,3$maturi, dan a?ot$mia
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c. Kelainan mukosa mata
- Didapatkan pada 80 % kasus
- Konjungtivitis
kataralis/konjungtivitis purulen- Kornea : erosi, perforasi, ulkus,
kekeruhan keutaan
- !ris : !ritis, uveitis, iridosilitis "
udem palpera
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DL
UL
G&uko(a dara3
!FT
LFT
BGA
Hi(topato&o#i
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$kro&i(i( Epid$rma& Tok(ik
G$'a&a k&inik 6
Akut, prodroma&
Ku&it 6 $rit$ma, 8$(iko"u&a,
purpura
iko&(k) (i#n 6 +@ &$"i3 dari- &ua( p$rmukaan tu"u3
Muko(a 6 (tomatiti(, kru(ta
m$ra3 k$3itaman Mata 6 kon'un#ti8iti(,
(im"&i9aron
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Stap3)&o=o===a& S=a&d$d Skin S)ndrom$+SSSS
G$'a&a k&ini(6
G$'a&a prodroma& d$n#an d$mam tin##i,di($rtai IS*A ($rin# pada n$onat$( dananak1anak
L$(i ku&it6 $rit$ma, "u&a k$ndor,
$pid$rmo&i(i( L$(i muko(a6 'aran# t$r'adi
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M!S Id$nti;ka(i dan p$n#3$ntiaan o"at )an# didu#a
($"a#ai p$n)$"a". *$r"aiki k$adaan umum dan k$($im"an#an =airan
$&$ktro&it dan prot$in, ($"$&umn)a dip$rik(a "$rat
'$ni( p&a(ma. kortiko(t$roid m$t3)& pr$dni(o&on
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S$p(i(
S)ok
Komp&ika(i pu&mona& +0
K$#a#a&an mu&tior#an +-
Komp&ika(i mata +4-1
ku&it 3ipopi#m$nta(i atau
3ip$rpi#m$nta(i, kuku m$n'adi di(tropik,p$ru"a3an pi#m$n dan anonikia
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*$n=$#a3anod$nti;ka(i dan 3indari
o"at p$n)$"a", m$n=$#a3 mun=u&n)akomp&ika(i
*ro#no(i( p$nata&ak(anaan )an# =$pat dan t$pat
pro#no(a "aik
Komp&ika(ipro#no(a "uruk
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