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Pustules in Stevens-Johnson Syndrome
Shunya Nagata1, Takaie Kuki1, Miyuki Kato2
1Department of General Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
The American Journal of Case Reports
|August 3, 2026
Summary
Stevens-Johnson syndrome (SJS) can rarely present with pustular lesions due to neutrophilic infiltration. Early diagnosis and treatment with corticosteroids, like prednisolone, are crucial for patient recovery.
Area of Science:
- Dermatology
- Immunology
- Pathology
Background:
- Stevens-Johnson syndrome (SJS) is a severe mucocutaneous reaction characterized by epidermal necrosis and mucosal involvement.
- While blister formation is common, pustular lesions are an atypical presentation of SJS.
Purpose of the Study:
- To report a rare case of Stevens-Johnson syndrome presenting with pustular lesions.
- To highlight the diagnostic challenges and treatment outcomes in such cases.
Main Methods:
- Clinical examination revealed fever, rash with pustules, erosions, and conjunctival pseudomembranes.
- Histopathology confirmed necrotic keratinocytes and serous exudate with neutrophils in pustules.
- A drug-induced lymphocyte stimulation test identified loxoprofen as the causative agent.
Main Results:
- A 25-year-old male presented with SJS, including unusual pustular lesions.
- The patient responded well to prednisolone therapy.
- Loxoprofen was identified as the likely trigger via a drug-induced lymphocyte stimulation test.
Conclusions:
- Stevens-Johnson syndrome can manifest with pustule-like eruptions due to neutrophilic infiltration.
- Diagnosis by exclusion and drug-induced lymphocyte stimulation tests are valuable.
- Prompt corticosteroid treatment is effective in managing SJS.
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