Dermatosis Mengancam Jiwa: Sindrom Stevens-Johnson Diduga Akibat Methampyron

Abstract

Sindrom Stevens-Johnson (SSJ) merupakan salah satu dermatosis yang mengancam jiwa dan merupakan bagian dari nekrolisis epidermal (NE), ditandai dengan reaksi mukokutan akut disertai nekrosis luas dan pengelupasan epidermis serta epitel mukosa. Kasus. Laki-laki usia 20 tahun dengan keluhan timbul ruam-ruam kemerahan sejak 2 hari di wajah, menyebar ke leher, dada, perut, punggung, kedua tangan, dan skrotum; diikuti bibir bengkak dan gelembung yang pecah meninggalkan bekas kehitaman. Diduga keluhan muncul setelah pasien mengonsumsi methampyron. Pasien memiliki riwayat systemic lupus erythematosus (SLE) terkontrol. Status dermatologi didapatkan purpura disertai bula dinding kendur pada regio coli, thorax, manus dekstra dan sinistra, dan abdomen. Tanda Nikolsky (+). Pada regio skrotum terdapat bula dinding kendur multipel dan sebagian erosi. Di regio labialis terdapat krusta merah kehitaman multipel, tebal, sulit dilepas, batas irreguler, dan sebagian erosi. Pasien didiagnosis sindrom Stevens-Johnson (SSJ) dan mendapat terapi cairan, methylprednisolone, paracetamol, gentamycin, curcuma, cetirizine, triamcinolone acetonide, desoximetasone, dan chloramphenicol. Pada hari ke-10 perawatan, pasien mengalami perbaikan klinis dan diperbolehkan pulang.

Stevens-Johnson syndrome (SJS) is one of the life-threatening dermatoses and a part of epidermal necrolysis (NE), characterized by mucocutaneous reaction, and followed by an extensive necrosis and detachment of epidermis and mucosal epithelium. A 20 year-old man complained of reddish rashes on the face since 2 days ago. The rashes widened and spread to the neck, body, stomach, back, both hands, and scrotum, followed by swollen lips and broken blisters that leave a blackish scar a day later. The symptoms were suspected to develop after taking methampyrone. The patient had a history of controlled Systemic Lupus Erythematosus (SLE). Dermatology status showed purpura and flaccid blisters on the neck, body, back, both hands, and abdomen, Nikolsky sign (+). Multiple flaccid blisters and partial erosion in the scrotum. On the lips, there are multiple reddish-black crusts, thick, hard to remove, irregular border, and partial erosion. The patient was diagnosed with Stevens-Johnson syndrome (SJS) and given fluid therapy, methylprednisolone, paracetamol, gentamicin, curcuma, cetirizine, triamcinolone acetonide, desoximetasone, and chloramphenicol. On the 10th day of the treatment, the patient was clinically improved and was discharged.