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Stevens-Johnson syndrome associated with cytomegalovirus infection in a child with ependymoma
Maria João Cruz1, Alberto Mota, Teresa Baudrier
1Department of Dermatology and Venereology, Hospital de São João, Porto, Portugal.
Background:
Stevens-Johnson syndrome is an uncommon, acute life-threatening disease characterized by extensive epidermal sloughing and mucositis. In childhood, as in adulthood, this condition is mostly related to drugs, in particular antibiotics. Only a few cases reported were firmly attributed to infectious agents, mainly Mycoplasma pneumonia but the causative role of infectious microorganisms seems particularly relevant in pediatric patients. The seriousness of this condition imposes a prompt recognition and the early withdrawal of the potential causative drugs or the institution of directed measures against infectious agents (depending on the suspected etiology), as well as a supportive and more specific therapy. Some treatments claim to halt the progression of skin detachment, but remain of unproven benefit due to the lack of prospective, well controlled, randomized clinical trials.
Main Observations:
We report a case of a 2-year-old boy admitted in our hospital for the treatment of an ependymoma of the posterior fossa, who developed a Stevens-Johnson syndrome associated most probably with a cytomegalovirus infection. He was successfully treated with high dose intravenous immunoglobulin and gancyclovir.
Conclusion:
To the best of our knowledge, this is the first case of SJS associated with CMV infection.
Insights
Stevens-Johnson syndrome (SJS) in children is rare and often drug-induced. This case highlights a potential link between SJS and cytomegalovirus (CMV) infection, successfully treated with IVIG and gancyclovir.
Area of Science:
- Pediatric Infectious Diseases
- Dermatology
- Clinical Case Reports
Background:
- Stevens-Johnson syndrome (SJS) is a severe, acute hypersensitivity reaction with significant epidermal and mucosal involvement.
- While often drug-induced, infectious agents are increasingly recognized as triggers, particularly in pediatric cases.
- Prompt recognition and management are crucial for improving patient outcomes.
Observation:
- A 2-year-old boy with posterior fossa ependymoma developed SJS.
- The SJS was strongly suspected to be associated with a cytomegalovirus (CMV) infection.
- The patient received high-dose intravenous immunoglobulin (IVIG) and gancyclovir.
Findings:
- This case represents the first reported instance of SJS associated with CMV infection.
- Successful treatment was achieved with a combination of IVIG and gancyclovir.
- The findings suggest CMV as a potential, albeit rare, cause of SJS in children.
Implications:
- Highlights the importance of considering infectious etiologies, including CMV, in pediatric SJS cases.
- Suggests IVIG and gancyclovir as a potential therapeutic strategy for SJS linked to CMV.
- Underscores the need for further research into the role of viral infections in SJS pathogenesis.
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