PA46 Clinical features, triggers and management of paediatric Stevens–Johnson syndrome: a case series from 2019 to 2024

Abstract Stevens–Johnson syndrome (SJS) is a severe mucocutaneous condition characterized by epidermal necrosis and mucosal involvement and is typically triggered by medications, although infections have also been implicated. Despite its rarity, and in some cases protracted course, prognosis tends to be more optimistic in children. This case series describes the clinical features, triggers, management strategies and outcomes of paediatric patients diagnosed with SJS at our institution over the last 5 years (2019–2024). We conducted a retrospective review of medical records for patients diagnosed with SJS (and in some instances mycoplasma-associated mucositis: MPAM). Inclusion criteria included a confirmed diagnosis based on clinical criteria and/or histopathological findings. Data collected encompassed demographic information, potential triggers, clinical presentation, treatment modalities and patient outcomes. In total four patients were identified. The mean age was 15 years (range 12–18), with a male-to-female ratio of 1 : 1. The triggers included Mycoplasma pneumoniae, varicella zoster, alpha-haemolytic Streptococcus and Epstein–Barr virus. Clinical features included mucocutaneous involvement in all cases. One patient developed urethral involvement and pulmonary sequelae, ultimately resulting in a pulmonary obliterans-type picture on imaging. This patient had Epstein–Barr virus (viral load > 138 IU mL−1). Treatment primarily involved supportive care, corticosteroids and close ophthalmology review, with 50% of these patients requiring amniotic membrane transplants. The average hospital stay was 21 days and there were no reported fatalities. This case series underscores the importance of recognizing SJS and MPAM early and identifying potential triggers. One patient was found on the ward 4 days after admission for ‘conjunctivitis, labial mucositis and a papular rash’. Effective management relies on prompt recognition and support of mucocutaneous involvement in sensitive sites.