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Stevens-Johnson Syndrome — RACP Adult Medicine MCQ

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EasyNeurologyStevens-Johnson SyndromeRACP Adult Medicine

A 25-year-old woman commenced on carbamazepine 2 weeks ago develops painful mucosal erosions (oral, ocular, genital), targetoid skin lesions, and widespread epidermal detachment affecting 8% BSA. She has high fever and is systemically unwell. Nikolsky sign is positive in affected areas. What is the most likely severe drug reaction?

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Correct answer: B — Stevens-Johnson syndrome

Mucosal involvement (≥2 sites), targetoid lesions with epidermal detachment <10% BSA, positive Nikolsky sign, and systemic toxicity defines SJS. Carbamazepine is a common cause (HLA-B*1502 screening recommended in Southeast Asian populations). SJS/TEN is a spectrum: <10% BSA = SJS, 10–30% = SJS-TEN overlap, >30% = TEN. Treatment is drug withdrawal, supportive care (burns unit), and possibly IVIG.

Reference: eTG Dermatology – 2024 – SJS/TEN; ALDEN Score