Journal of the korean academy of Pediatric Dentistry (대한소아치과학회지)

Korean Academy of Pediatric Dentistry (대한소아치과학회)
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Stevens-Johnson Syndrome : A Case Report

스티븐 존슨 증후군 : 증례보고

  • Song, Yongho (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Lee, Nanyoung (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Lee, Sangho (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Jih, Myeongkwan (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Lim, Yujin (Department of Pediatric Dentistry, College of Dentistry, Chosun University) ;
  • Yoon, Youngmi (Department of Pediatric Dentistry, College of Dentistry, Chosun University)
  • 송용호 (조선대학교 치과대학 소아치과학교실) ;
  • 이난영 (조선대학교 치과대학 소아치과학교실) ;
  • 이상호 (조선대학교 치과대학 소아치과학교실) ;
  • 지명관 (조선대학교 치과대학 소아치과학교실) ;
  • 임유진 (조선대학교 치과대학 소아치과학교실) ;
  • 윤영미 (조선대학교 치과대학 소아치과학교실)
  • Received : 2017.03.02
  • Accepted : 2017.03.18
  • Published : 2017.11.30
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Abstract

Stevens-Johnson syndrome (SJS), an extremely severe acute hypersensitivity reaction, causes extensive necrosis on the skin and the mucous membrane. SJS is a disease of unknown cause that can occur in all age groups. It is thought to be caused by drug allergy or induced by bacterial infection. Epidermal surface invasion of less than 10 percent is called SJS, and invasion of more than 30 percent is called toxic epidermal necrolysis. Although it is rare with an incidence of 1 - 2 cases per million people per year, it has effects on tooth development and therefore on children who are in a growth phase. The purpose of this case report is to examine the effect of SJS on tooth development in children. In general, eruption of the upper and lower 1st molars and lower central incisors starts at 6 - 7 years of age. Root development also occurs at this time. In the case reported here, SJS occurred in a 6-year-old patient. Although the patient's SJS was completely cured, he still suffers from aftereffects. Developmental abnormalities in the patient's teeth were observed only in teeth for which root development had been completed at the time. The purpose of this case report is to illustrate how to diagnose such systemic diseases by intra-oral features and to recognize and resolve tooth development problems associated with the disease.

스티븐 존슨 증후군(Stevens-Johnson syndrome, SJS)은 피부와 점막에 광범위한 괴사를 초래하는 매우 심각한 급성 과민반응이다. SJS은 모든 연령대에서 발생할 수 있는 질환으로 원인은 명확하지는 않지만 대부분 약물 알레르기에 의한 것으로 알려져 있으며 그 외에도 세균감염에 의해 유발되기도 한다고 알려져 있다. 전체 표피면적의 10% 이하에서 병변이 발생한 경우를 SJS라 하며 30% 이상에서 발생한 경우를 독성 표피 괴사융해라 정의한다. SJS는 1년에 100만명 인구 당 1 - 2명 미만에서 드물게 발생하나, 성장기 어린아이에게 발생할 경우 치아발육 등에 미치는 영향을 미치게 된다. 6 - 7세경 상하악 제1대구치와 하악중절치의 맹출이 시작되고 이 시기에 치근의 발육이 함께 일어난다. 이 케이스의 환아의 경우 6세경 SJS이 발병하였다. 현재 완치된 상태이나 몇몇 후유증이 남아있는 상태이다. 환아는 이 시기에 발육이 완성되는 치아에 국한되어 발육이상이 관찰되었다. 구강내 특징으로 이러한 전신질환을 진단하고 이로 인한 치아 발육에 대한 영향에 대한 문제점을 인식하고 해결하고자 이 보고서를 쓰는 바이다.

Keywords

References

  1. Borchers AT, Lee JL, Gershwin ME, et al. : Stevens-Johnson syndrome and toxic epidermal necrolysis. Autoimmun Rev, 7:598-605, 2008. https://doi.org/10.1016/j.autrev.2008.06.004
  2. Łoboda J, Dudzik A, Chomyszyn-Gajewska M : Stevens-Johnson syndrome and toxic epidermal necrolysis-based on literature. Przegl Lek, 72:35-37, 2015.
  3. Tristani-Firouzi P, Petersen MJ, Zone JJ, et al. : Treatment of toxic epidermal necrolysis with intravenous immunoglobulin in children. J Am Acad Dermatol, 47:548-552, 2002. https://doi.org/10.1067/mjd.2002.127249
  4. Prins C, Kerdel FA, French LE, et al. : Treatment of toxic epidermal necrolysis with high-dose intravenous immunoglobulins: multicenter retrospective analysis of 48 consecutive cases. Arch Dermatol, 139:26-32, 2003. https://doi.org/10.1001/archderm.139.1.26
  5. Auquier-Dunant A, Mockenhaupt M, Roujeau JC, et al. : Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: results of an international prospective study. Arch Dermatol, 138:1019-24, 2002.
  6. Harr T, French LE : Stevens-Johnson syndrome and toxic epidermal necrolysis. Chem Immunol Allergy, 97:149-166, 2012.
  7. KDA Textbook editing board : Dermatology, 5th ed., Ryomoongak, 221-227, 2008.
  8. Bajaj N, Madan N, Rathnam A : Cessation in root development: ramifications of 'Stevens-Johnson' syndrome. J Indian Soc Pedod Prev Dent, 30:267-270, 2012. https://doi.org/10.4103/0970-4388.105023
  9. De Man K : Abnormal root development, probably due to erythema multiforme (Stevens-Johnson syndrome). Int J Oral Surg, 8:381-385, 1997.
  10. Brook U : Stevens-Johnson syndrome and abnormal root development: a case report. Int J Paediatr Dent, 4:101-103, 1994. https://doi.org/10.1111/j.1365-263X.1994.tb00112.x
  11. LIBRACH IM : Erythema multiforme bullosa (Stevens-Johnson Syndrome); some observations on pathogenesis and on treatment with cortisone and ACTH. Postgrad Med J, 31:570-574, 1995.
  12. Shetty SR, Chatra L, Shenai P, Rao PK : Stevens-Johnson syndrome: a case report. J Oral Sci, 52:343-346, 2000.
  13. Apajalahti S, Holtta P, Turtola L, Pirinen S : Prevalence of short-root anomaly in healthy young adults. Acta Odontol Scand, 60:56-9, 2002. https://doi.org/10.1080/000163502753472014
  14. Bachot N, Roujeau JC : Differential diagnosis of severe cutaneous drug eruptions. Am J Clin Dermatol, 4:561-572, 2003. https://doi.org/10.2165/00128071-200304080-00006
  15. Fritsch PO, Sidoroff A : Drug-induced Stevens-Johnson syndrome/toxic epidermal necrolysis. Am J Clin Dermatol, 1:349-360 2000. https://doi.org/10.2165/00128071-200001060-00003
  16. Bastuji-Garin S, Rzany B, Roujeau JC, et al. : Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol, 129:92-96, 1993. https://doi.org/10.1001/archderm.1993.01680220104023
  17. Assier H, Bastuji-Garin S, Revuz J, Roujeau JC : Erythema multiforme with mucous membrane involvement and Stevens-Johnson syndrome are clinically different disorders with distinct causes. Arch Dermatol, 131:539-543, 1995. https://doi.org/10.1001/archderm.1995.01690170041005
  18. Oliveira LR, Zucoloto S : Erythema Multiforme Minor: A Revision. American Journal of Infectious Disease, 4:224-231, 2008. https://doi.org/10.3844/ajidsp.2008.224.231
  19. Del Pozzo-Magana BR, Lazo-Langner A, Rieder MJ, et al. : A systematic review of treatment of drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in children. J Popul Ther Clin Pharmacol, 18:121-133, 2011.
  20. Bachot N, Revuz J, Roujeau JC : Intravenous immunoglobulin treatment for Stevens-Johnson syndrome and toxic epidermal necrolysis: a prospective noncomparative study showing no benefit on mortality or progression. Arch Dermatol, 139:33-36, 2003.
  21. Huang X, Bringas P Jr, Slavkin HC, Chai Y : Fate of HERS during tooth root development. Dev Biol, 334:22-30, 2009. https://doi.org/10.1016/j.ydbio.2009.06.034
  22. Ranalli DN, Elliott MA, Whaley TM, Campagna ED Jr : Stevens-Johnson syndrome: report of case with abnormal root development. ASDC J Dent Child, 51:298-301, 1984.