SJS with Mucosal Erosions MCQ — NEET PG Practice Question | NEETPGAI
SJS with Mucosal Erosions
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hand Dermatology
A 30-year-old man with HIV on trimethoprim-sulfamethoxazole prophylaxis for 3 weeks presents with fever, severe oral erosions preventing oral intake, purulent conjunctivitis with photophobia, painful genital ulcers, and atypical targetoid lesions with dusky centres on the trunk. Epidermal detachment is approximately 6% BSA. Histology confirms full-thickness keratinocyte apoptosis with subepidermal split and sparse dermal infiltrate, consistent with Stevens-Johnson syndrome (SJS). Which of the following management approaches best represents the standard of care for this patient, as indicated by **B** in the diagram?
A. Outpatient antihistamines and topical steroids alone, with close follow-up
B. Stop the offending drug immediately, admit to a burn unit or ICU, provide supportive care with multidisciplinary mucosal protection including ophthalmology and urology consultation
C. Initiate IV broad-spectrum antibiotic prophylaxis without identifying the culprit drug while continuing current medications
D. Continue trimethoprim-sulfamethoxazole if symptoms appear mild, supplemented with systemic corticosteroids
Explanation
Why option B is correct
The management of SJS requires immediate identification and cessation of the culprit drug (trimethoprim-sulfamethoxazole in this case), as every 24-hour delay in withdrawal worsens outcomes. The patient must be admitted to a burn unit or ICU experienced in managing SJS/TEN. Supportive care includes fluid resuscitation (~⅔ Parkland formula), nutritional support via nasogastric tube when oral intake is impossible, careful wound care with non-adherent dressings, and strict temperature control. Critically, multidisciplinary mucosal care is essential: daily ophthalmology review with preservative-free lubricants and amniotic membrane transplant for severe ocular involvement (to prevent symblepharon and visual loss), urology consultation for urethral toilet, and gynaecology consultation for vaginal stenosis prevention. SCORTEN should be calculated within 24 and 72 hours for prognostic stratification. This approach directly aligns with BAD SJS/TEN Guidelines 2016 and Bastuji-Garin SCORTEN 2000 recommendations.
Why each distractor is wrong
Option A (Outpatient antihistamines and topical steroids alone): SJS with 6% BSA epidermal detachment is a life-threatening dermatological emergency requiring inpatient burn-unit-level care. Outpatient management is inappropriate and delays critical interventions. Antihistamines alone do not address the underlying CD8 T-cell–mediated keratinocyte apoptosis.
Option C (IV broad-spectrum antibiotic prophylaxis without identifying the culprit): Prophylactic systemic antibiotics are explicitly avoided in SJS management unless there is documented infection, as they increase morbidity without benefit. Continuing the offending drug while adding antibiotics does not address the primary pathology and delays drug withdrawal, worsening prognosis.
Option D (Continue drug if symptoms appear mild): Continuing trimethoprim-sulfamethoxazole in a patient with confirmed SJS is contraindicated and dangerous. The severity of SJS (6% BSA) is not "mild," and continuation perpetuates the CD8 T-cell–mediated keratinocyte apoptosis. Systemic corticosteroids alone are controversial and ineffective without drug cessation.
High-YieldNEET PG
In SJS, the golden rule is: identify and stop the culprit drug within 24 hours, admit to a burn unit, calculate SCORTEN, provide multidisciplinary mucosal care (especially ophthalmology with amniotic membrane transplant), and avoid prophylactic antibiotics.
BAD SJS/TEN Guidelines 2016; Bastuji-Garin SCORTEN 2000; Roujeau Algorithm of Drug Causality (ALDEN) 2010
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