Patient Expires Following Delayed Diagnosis Of Stevens-Johnson Syndrome

This case involves a 36-year-old male patient with a history of PTSD who went to the hospital for treatment of an anxiety attack. He was given medication and discharged within the day. He returned to the hospital one week later with a rash from head to toe. He was admitted and quarantined for suspicion of measles. The doctors later determined she had Stevens-Johnson Syndrome, but they did not arrive at this diagnosis for almost 4 days. The patient was then given a feeding tube. The patient was not given a rectal tube, however, and the patient proceeded to soil himself. For this, the patient was treated as if he had a burn: the nurses lubricated the patient’s skin and put silver patches on. The patient never recovered from the Stevens-Johnson Syndrome and eventually died. An expert in dermatology was sought to review the records and opine on whether an earlier diagnosis may have improved the patient’s prognosis.

Question(s) For Expert Witness

1. How often do you diagnose Stevens-Johnson Syndrome?

2. What are some signs/symptoms that would differentiate Stevens-Johnson Syndrome from measles?

3. Can an early diagnosis of Stevens-Johnson Syndrome halt its progression? Please explain.

Expert Witness Response E-087341

Luckily, Stevens-Johnson Syndrome is rare. I have personally cared for two patients with Stevens-Johnson Syndrome in the past 6 months. I take calls for 2 weeks every 2 months at the dermatology inpatient consultation service, which is where we typically see and treat Stevens-Johnson Syndrome. I also maintain a busy outpatient clinic schedule. I published an article on Stevens-Johnson Syndrome some time ago and have been interested in this entity ever since. Measles is not on the list of differential possibilities with typical Stevens-Johnson Syndrome lesions. Maybe in the first few hours of the rash, an attending physician could possibly be confused, but not as the disease progresses beyond that. The rash is different. The mucous membrane lesions are different. The diseases are as different as cats are from dogs. Based on clinical experience, the sooner Stevens-Johnson Syndrome is diagnosed, the better the outcome.