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