Objective:

Pregnancy with SJS/TEN is a unique subset that adversely affect the woman and her baby. We here present a case of high-risk pregnancy, complicated by SJS/TEN. The patient had passed through an extremely turbulent and life- threatening hospital course and the management was quite challenging for the multidisciplinary professional team, with a good outcome.

Case report:

A lady in her 30’s, she is G6 P5 with previous five caesarean sections. She has class 3 obesity and has undergone two bariatric surgeries before. Consequently, she developed anemia, dumping syndrome and hypoproteinemia, and has had multiple prior hospital admissions from 19 weeks+ of gestation.

Admitted as a case diarrhea positive stool culture with Salmonella, for which she received cephalosporins. Complicated by sepsis, renal failure, and myocarditis, arrested, resuscitated, and cared for in ICU. Skin biopsy confirmed SJS/TEN, at 29 weeks + 5 days, she had superimposed preeclampsia for which caesarian section done, developed all known postpartum complications, managed by multidisciplinary team, and discharged in good condition after 32 days.

Discussion:

Steven-Johnson syndrome SJS/ Toxic Epidermal Necrosis TEN is a serious immune-complex-mediated cutaneous adverse drug reaction characterized by variable skin lesions.

Our patient had the full picture of this disease, it was most probably mediated by Cephalosporins.

She had sustained all the complications associated with this disease, including pneumonia, myocarditis, renal failure, metabolic imbalance, sepsis, and postpartum hemorrhage.

Added to that, the presence of obesity on its own, super imposed preeclampsia, and delivery by caesarian section, complicated the case more and make it challenge to the multidisciplinary team.

The out com for both were invaluable and it made a great addition to the happy finale.

Conclusion:

Steven -Johnson syndrome SJS/ Toxic Epidermal Necrosis TEN is a rare fetal condition that needs careful subscription of antibiotics and careful assessment upon occurrence.

We believe that the speech delivered by William J. Mayo, (The pioneer of multidisciplinary concept), in his 1910 commencement, has helped in reforming a new era of improved health care delivery, it stated: “It has become necessary to develop medicine as a cooperative science, the clinicians, the specialists, and the laboratory workers uniting for the good of the patent. Each assisting in elucidation of the problem at hand and each dependent upon the other for support”

Indeed, it’s true, the presence of the Multidisciplinary team, obstetricians, dermatologists, intensivists, and neonatologists had clear impacts in saving this patient’s life.