Introduction:
Stevens-Johnson Syndrome (SJS) is a dermatological emergency, characterised by painful mucocutaneous blistering with epidermal detachment and subsequent widespread skin loss. It usually presents secondary to a medication trigger, and less commonly due to infection. We report the only known case of SJS secondary to Chlamydia Trachomatis (CT).
Report:
A 20-year-old male presented with painful oral and genital mucosal ulceration, with associated blistering of the trunk and limbs. There had been no prodrome and no infective symptomatology. He had no significant past medical history, no regular medications and no new prescription, illicit or over-the-counter medications. He had no known allergies.
On examination, there were widespread dusky targetoid macules over the back, chest and limbs, which demonstrated a positive Nikolsy sign. There was palmoplantar blistering and erosion of the oral mucosa. Total body surface area of active skin involved was 89%, with 5% surface area of epidermal detachment.
Initial baseline bloods were unremarkable, but C-reactive protein and erythrocyte sedimentation rate were raised, 349mg/L and 38mm/hr respectively. Full serological infective screen was negative. Skin biopsy showed extensive areas of full-thickness epidermal keratinocyte necrosis with associated subepidermal blister formation. Direct immunofluorescence was negative. These findings were consistent with the clinical suspicion of SJS. Given the lack of medication trigger, a urine screen was performed, which revealed CT infection.
The patient was commenced on intravenous immunoglobulin, topical corticosteroids and azithromycin, and received SJS ward-based care, with good clinical response.
Conclusion:
In over 80% of SJS presentations, a temporal relationship can be found with a culprit drug trigger. Less commonly, vaccination and infection have been reported to be disease triggers. This is the only known reported case of SJS secondary to CT. In the absence of a clear medication trigger with a case of SJS, it may be important to consider CT as a cause.