A case of Stevens-Johnson syndrome with a rash predominantly on the palms.

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  • Takada Keiko
    Department of Dermatology and Allergology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
  • Noguchi Atsushi
    Department of Dermatology and Allergology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
  • Senda Kaori
    Department of Dermatology and Allergology, Juntendo University Shizuoka Hospital, Shizuoka, Japan
  • Hasegawa Toshio
    Department of Dermatology and Allergology, Juntendo University Shizuoka Hospital, Shizuoka, Japan

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Other Title
  • 手掌に優位な分布を呈したStevens-Johnson症候群の1例
  • シュショウ ニ ユウイ ナ ブンプ オ テイシタ Stevens-Johnson ショウコウグン ノ 1レイ

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Abstract

A 25-year-old woman had taken acetaminophen for menstrual pain and eletriptan hydrobromide for migraine irregularly. Four days before her first visit to our hospital, she had a fever and took an over-the-counter cold medicine(loxoprofen sodium hydrate). The next day, skin eruption appeared on her palms, and she was treated with levofloxacin and acetaminophen by her family doctor. Two days later, she was referred to our hospital for eye discharge, pain in the palms, and pain during urination. She had fever; red eyes; erosions on the lips, oral cavity, and vulva; and a target-like rash on the palms. She was diagnosed with Stevens-Johnson syndrome based on histological findings of the palm skin revealing epidermal necrosis.Loxoprofen sodium hydrate was thought to be suspicious drug for this skin rash from the clinical course and the result of drug-induced lympocyte stimulation test. Treatment with prednisolone succinate sodium at a dose of 1mg/kg/day was initiated. Three days later, the dose of prednisolone succinate sodium was increased to 1.5 mg/kg/day because the blisters on the palms enlarged. Four days later, she started to eat. Thirteen days after the start of treatment, eye sebum began to decrease, and the dose of prednisolone succinate sodium was gradually reduced. Although the skin rash of Stevens-Johnson syndrome usually appears predominantly on the trunk, it appeared predominantly on the palms in our case. when we see a rash predominantly on the palms, we should be caucious about the progression to STS by checking systemic and mucosal symptoms.

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