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Esophageal involvement in Stevens-Johnson syndrome
T Lamireau1, C Leauté-Labrèze, B Le Bail
1Division of Pediatric Gastroenterology, Children 's Hospital, Bordeaux, France. thierry.lamireau@chu-bordeaux.fr
Insights
Stevens-Johnson syndrome can cause severe esophageal blistering and ulcerations, potentially worsening malnutrition. Early enteral nutrition is crucial for feeding, weight management, and healing in affected children.
Area of Science:
- Pediatric Gastroenterology
- Dermatology
- Critical Care Medicine
Background:
- Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reaction often involving the gastrointestinal tract.
- Esophageal complications in pediatric SJS are frequently underestimated, impacting nutritional status.
- Understanding the endoscopic manifestations is key to managing SJS patients.
Observation:
- Endoscopic evaluation revealed extensive esophageal lesions in five pediatric SJS cases.
- Lesions included epithelial blistering and significant mucosal ulcerations throughout the esophagus.
- Oral lesions commonly coexist, exacerbating dysphagia and malnutrition risks.
Findings:
- Esophageal involvement in SJS is likely underdiagnosed and contributes significantly to patient morbidity.
- Enteral nutrition demonstrated benefits in providing nutrition, preventing weight loss, and supporting healing.
- No esophageal strictures were observed during the follow-up period in these patients.
Implications:
- Highlights the importance of considering and evaluating esophageal involvement in pediatric SJS.
- Emphasizes the therapeutic role of enteral nutrition in managing severe SJS.
- Suggests a potentially favorable prognosis regarding stricture formation with appropriate management.
Abstract:
The authors describe the endoscopic aspect of esophageal lesions in five children with Stevens-Johnson syndrome. Lesions involve the entire esophagus, with blistering of the epithelium leading to large ulcerations of the mucosae. Esophageal involvement is probably underestimated in Stevens-Johnson syndrome and may worsen dysphagia caused by oral lesions, leading to malnutrition. Enteral nutrition can be helpful to provide feeding, limit weight loss, and support skin healing. No strictures were diagnosed during the follow-up period of these patients.