中华皮肤科杂志 ›› 2007, Vol. 40 ›› Issue (4): 196-198.

• 论著 • 上一篇    下一篇

无皮疹型Stevens-Johnson综合征四例

姚志荣, 陈洁, 祁怀山, 鲁智勇, 庄寅, 姜嫒芳, 郭一峰   

  1. 上海交通大学附属新华医院皮肤科, 200092
  • 收稿日期:2006-06-02 出版日期:2007-04-15 发布日期:2007-04-15
  • 通讯作者: 姚志荣,email:zryaosmu@sohu.com E-mail:zryaosmu@sohu.com

Stevens-Johnson syndrome without skin lesions： a report of 4 cases

YAO Zhi-rong, CHEN Jie, QI Huai-shan, LU Zhi-yong, ZHUANG Yin, JIANG Ai-fang, GUO Yi-feng   

  1. Department of Dermatology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
  • Received:2006-06-02 Online:2007-04-15 Published:2007-04-15

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摘要： 目的 报道4例无皮疹型Stevens-Johnson综合征,并对该病有关文献进行综述.方法 对4例患者的发病因素、临床特征及治疗进行较为系统地观察.结果 4例均为儿童,表现有发热,口唇黏膜肿胀、糜烂、出血性渗出和坏死,3例有结膜炎症,其中2例出现睑结膜纤维素样渗出;4例都无明显皮肤损害.3例进行了肺炎支原体抗体和冷凝集试验检测,肺炎支原体抗体IgG全部阳性,冷凝集试验仅1例阳性,为1:128(正常低于1:32).2例入院前诊断"化脓性扁桃体炎",其中1例发疹时抗链球菌溶血素O试验1240 Iu/mL阳性(正常低于200 IU/mL).2例柯萨奇病毒IgM检测阳性.单用抗生素治疗无效,对糖皮质激素治疗敏感,4例均痊愈.结论 无皮疹型Stevens-Johnson综合征的预后较好,其病因仍以感染为主,尤其是肺炎支原体、病毒感染更应加以重视.

关键词: 中毒性表皮松解症, stevens-Johnson综合症, 皮质类固醇激素, 静脉注射丙种球蛋白, 联合治疗, SCORTEN, Stevens-Johnson综合征, 支原体,肺炎, 柯萨奇病毒感染

Abstract: Objective To report 4 cases of Stevens-Johnson syndrome(SJS) without skin lesions and to review relevant literature.Methods A prospective and systemic study was conducted on etiological factors,clinical manifestations and management of 4 patients,who were inpatients of our hospital.Results All the patients were children,presenting with fever,as well as swelling,erosion,necrosis and hemorrhagic exudates on the oral mucosa.Of the 4 patients,3 had conjunctivitis,2 had fibrous exudates on the eyelid conjunctiva with pseudomembrane formed.None of the 4 cases had typical skin lesions.Of 3 patients who underwent anti-Mycoplasma pneumoniae IgG detection and cold agglutination test,all were positive for anti-Mycoplasma pneumoniae antibody,while only one had a higher cold agglutinin titer(1:128).Two patients had a history of suppurative tonsillitis prior to the hospitalization,and one of them had a high antistreptalysin O titer of 124U IU/mL.Anti-Coxsackie virus IgM was positive in 2 patients.All the patients failed to response to antibiotic therapy but were successfully treated by glucocorticosteroids.Conclusions The prognosis of SJS without skin lesions seems to be better than that of SJS with skin Lesions.SJS without skin lesions may be primarily associated with infections,especially Mycoplasma pneumoniae and viral infection.

Key words: Stevens-Johnson syndrome, Mycoplasma pneumoniae, Coxsackievirus infections