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Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are adverse drug reactions. Objectives To learn about the clinical characteristics of patients with SJS/TEN including treatments provided, outcomes, and mortality. Methods We conducted a retrospective chart review of patients who were hospitalized with the diagnosis of SJS/TEN at the Ross Tilley Burn Center between the years 1999 and 2015. Results A total of 43 patients were identified with a mean age of 54 ± 19 (58, 18-85). The most common offending medications were allopurinol and carbamazepine. The overall mortality rate in our study is 21% with the most common causes of death being multiorgan failure and sepsis. The majority of our patients had oral (84%), ocular (79%), and genital (60%) involvement during hospitalization. Our data revealed that combination treatment involving oral corticosteroids with intravenous immunoglobulin (IVIG) had the highest mortality rate in our study since 55% (6/11) of patients who were treated in this manner passed away compared to 11% (2/18) of patients passing away who were treated with solely IVIG and 33% (1/3) who were treated with only supportive care. Our study also demonstrates the addition of etanercept and cyclosporine treatment in the second time period we studied: 2008-2015 versus the earlier time period of 1999-2007. None of the patients in our study who were treated with therapies including cyclosporine and/or etanercept passed away. Conclusions Our study sheds light on a possible beneficial role of cyclosporine and etanercept for the treatment of SJS and TEN and reinforces the necessity of a multidisciplinary care team for patients.

Pediatric multi-systemic inflammatory syndrome (PIMS) has gained attention throughout the medical world due to the ongoing SARS COV 2 pandemic. Being a systemic inflammatory response, cardiovascular complications are no exception, thus awareness of such conditions must be raised, as well as of prompt and accurate diagnosis and treatment. Attention is particularly brought to PIMS due to the fact that symptoms of it overlap with Kawasaki disease and toxic shock syndrome. The aim of this paper is to present cardiac findings and short-term outcomes in children with PIMS admitted to one of the main pediatric emergency health care units in Romania.This current paper draws data from a single center, and is an observational, prospective study. The number of patients that were included in this study is 26, with age range between 1 month and 17 years, hospitalized between December 2020 and April 2021 in the ‘Grigore Alexandrescu’ Emergency Hospital for Children, Bucharest. The main criterion for inclusion was PIMS as defined by CDC/WHO case definition. Out of all symptoms, persistent fever and gastrointestinal conditions were de most frequent ones (88% and 69%, respectively).Cardiac involvement was found in 11 patients (42%), being represented by: left ventricular dysfunction (26%), coronary artery abnormalities (15%), atrioventricular valve regurgitation (30%), with only one patient showing pericardial effusion and one an ECG anomaly. Improvement of initial clinical symptoms was paralleled by alleviation of cardiac symptomatology, as well as normalization of cardiac and inflammatory laboratory findings.Our study shows that cardiac involvement is frequent in pediatric population with systemic inflammatory syndrome and we believe that PIMS in SARS COV 2 infected patients should be thoroughly screened and treated by a multi-disciplinary team. 24 out of 26 patients were fully recovered and discharged without sequelae, but two patients with persistent coronary artery aneurysmal findings.

Introduction Kawasaki disease is an acute febrile vasculitis, primarly affecting children, that is epidemiologically and clinically closely linked to a viral infection (2). This entity can sometimes have severe forms. Numerous clinical studies published in the last two years have shown that infection with SARSCoV2 virus (COVID 19) in children is frequently associated with this entity, which can sometimes be severe. We will present the case of a 9-month-old infant, without personal history, who was hospitalized for fever. The onset of the disease was 14 days earlier, with high fever and rash. He was hospitalized in another clinic, where the diagnosis of Covid 19-associated Kawasaki Disease was established (the criteria were as follows: fever for longer than 5 days, papulo-erythematous rash on the chest and limbs, changes in the oral and lip mucosa, palmo-plantar edema, bilateral conjunctivitis, Ig G anti SARS CoV2=4.52u/ml). He received treatment with Gamma globulin 2g/kg in single dose, corticosteroid therapy, Aspirin. The evolution was initially favorable. But after 7 days, high fever reappeared. Then, he is hospitalized in our clinic. At admission he had high fever, hyperemic lips, bilateral conjunctivitis, no manifestations of cardiac dysfunction, leukocytosis: 26,700/mmc, marked inflammatory syndrome (ESR=130 mm/ h, C-reactive protein=8.8 mg/dl). Cardiac ultrasound detects an aneurysm of the coronary arteries (RCA=3.5mm, Z score=6, LCA=2.5mm, Z score=1.43). The diagnosis of Kawasaki disease refractory to immunoglobulin treatment has been established, resuming administration in a dose of 400 mg/kg of body weight/day for 3 days. Treatment was supplemented with intravenous methylprednisolone pulse therapy, aspirin and enoxaparin.(1) The evolution was favorable with the remission of clinical symptoms and inflammatory syndrome, but with the persistence of coronary dilation. He was discharged from hospital with good general condition, normal inflammatory markers, changes in lipid profile (total cholesterol=306 mg/dl, total lipids=951 mg/dl, triglycerides=172 mg/dl) and indications of treatment with Medrol 2 mg/kg with gradual reduction of dosage and Aspirin 4mg/kg. After about 1 month he returns for revaluation, showing good general condition, upward weight curve, biological samples within normal limits. Ultrasound cardiological reassessment and CT angiography further reveal significant aneurysmal dilatation of the left coronary artery. Anticoagulant treatment was completed with enoxaparin. Conclusions KAWASAKI disease associated with COVID 19, may present an unfavorable outcome with lack of response to the initial immunoglobulin treatment and evolution to coronary aneurysm.

The authors regret not all contributing authors correctly acknowledged funding. Jonathan Peter’s IMARI-Africa project (AFRISCAR) is part of the EDCTP2 programme supported by the European Union (grant number TMA2017SF-1981 ). The authors would like to apologise for any inconvenience caused.

Few studies have reported the physical complications among Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) survivors. The aim of this study was to comprehensively characterize the physical complications among SJS/TEN survivors and to learn about patients’ perspectives of surviving SJS/TEN. SJS/TEN survivors older than 18 years of age were assessed by different methods: a medical interview; a questionnaire assessing patients’ perspectives; thorough skin, oral mucous membrane, and ophthalmic examinations; and a retrospective assessment of medical records. Our cohort consisted of 17 patients with a mean time of 51.6 ± 74.7 months (median 9, range 1–228) following SJS/TEN. The most common physical complications identified in the medical examination were post-inflammatory skin changes (77%), cutaneous scars (46%), dry eyes (44%), symblepharon, and chronic ocular surface inflammation (33% each). Novel physical sequelae included chronic fatigue (76%) and pruritus (53%). We also found a novel association between the number of mucous membranes affected in the acute phase of SJS/TEN and hair loss during the 6 months following hospital discharge; hair loss was reported in 88% of the group of patients who had three or more mucous membranes affected versus 29% of patients who had less than three mucous membranes involved (p = 0.0406). Following hospital discharge due to SJS/TEN, 59% of patients were followed by a dermatologist, although 88% had dermatological complications; 6% were followed by an ophthalmologist, even though 67% had ophthalmological complications; and 6% of female survivors were followed by a gynecologist, even though 27% had gynecological complications. Survivors of SJS/TEN suffer from severe physical complications impacting their health and lives that are mostly under recognized and not sufficiently treated by medical professionals.

Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are potentially life-threatening, immune-mediated adverse reactions characterized by widespread erythema, epidermal necrosis, and detachment of skin and mucosa. Efforts to grow and develop functional international collaborations and a multidisciplinary interactive network focusing on SJS/TEN as an uncommon but high burden disease will be necessary to improve efforts in prevention, early diagnosis and improved acute and long-term management. SJS/TEN 2019: From Science to Translation was a 1.5-day scientific program held April 26-27, 2019, in Vancouver, Canada. The meeting successfully engaged clinicians, researchers, and patients and conducted many productive discussions on research and patient care needs.

Websites for residency and fellowship programs serve as effective educational and recruitment tools.To evaluate the accessibility and content of fellowship websites that are commonly used by microsurgery applicants for career development.A list of one-year microsurgery fellowship websites (MFWs) was compiled by visiting the centralized American Society for Reconstructive Microsurgery (ASRM) website, followed by performing an extensive 'Google' search in October 2015. Accessibility of MFWs was assessed. Website content regarding key recruitment and education variables was also comprehensively reviewed. Website content was correlated with program characteristics usingA list of 53 eligible programs was compiled. Only 15 of 51 (29%) ASRM program links were functional. On average, the combined content from ASRM website and individual MFWs had 2.91 of 6 recruitment variables and 1.32 of 6 education variables, respectively. The majority of programs listed 'eligibility criteria' (87%) and 'general information' (87%). 'Evaluation criteria' were most poorly reported (4%). Recruitment score was higher for United States programs compared with international counterparts (51% versus 33%, respectively; P=0.02). It was also higher in programs that focus on 'extremity' versus 'breast' (58% versus 37%; P=0.0028). Education scores did not differ according to location, program size, subspecialty of focus or participation in the Microsurgery Match process.Information regarding recruitment and education on most MFWs is scarce. Academic institutions should keep website content up to date and comprehensive to better assist candidates in the application process.Les sites Web pour les programmes de résidence et de surspécialisation sont des outils de formation et de recrutement efficaces.Évaluer l’accessibilité et le contenu des sites Web de surspécialisation souvent utilisés par les candidats en microchirurgie en vue de leur perfectionnement de carrière.Les chercheurs ont compilé la liste des sites Web de surspécialisation en microchirurgie (SSW) d’un an à partir du site Web centralisé de l’Les chercheurs ont compilé une liste de 53 programmes admissibles. Seulement 15 liens sur les 51 programmes de l’ASRM (29 %) étaient fonctionnels. En moyenne, le contenu combiné du site Web de l’ASRM et des SSW individuels disposait de 2,91 des six variables de recrutement et de 1,32 des six variables de formation, respectivement. La majorité des programmes comportaient un volet « Critères d’admissibilité » (87 %) et un volet « Renseignements généraux » (87 %). Les « critères d’évaluation » étaient moins bien définis (4 %). Le score de recrutement était plus élevé aux États-Unis que dans les programmes internationaux (51 % par rapport à 33 %, respectivement; P=0.02). Il était également plus élevé dans les programmes axés sur les membres que sur les seins (58 % par rapport à 37 %; P=0,0028). Les scores de formation étaient similaires à l’égard du lieu, de la dimension du programme, de la surspécialisation d’intérêt ou de la participation au processus de jumelage en microchirurgie.Il y a peu d’information relative au recrutement et à la formation dans la plupart des SSM. Les établissements universitaires devraient maintenir le contenu de leur site à jour et complet afin de mieux aider les candidats dans le cadre de leur processus de candidature.

Drug eruptions have a wide spectrum of clinical manifestations, are caused by various drugs, and result from varied pathophysiological mechanisms. Hence, their diagnosis and management is challenging. Drug eruptions can range from a mild, simple eruption involving only the skin to severe complex eruptions with systemic involvement, such as toxic epidermal necrolysis. Systemic involvement should be explored even in a mild cutaneous eruption due to a drug since the severity of skin manifestation does not necessarily mirror the severity of the systemic involvement. This chapter aims to provide a practical approach to a patient with a suspected drug eruption.

Sarcoidosis is an idiopathic disease, characterized by non-caseating granulomas in multiple organs/tissues. Cutaneous involvement occurs in approximately one-quarter of patients with a wide variety of presenting morphologies. This case report describes a case of photodistributed sarcoidosis, a rare cutaneous variant, with systemic involvement. A 42-year-old man presented with a history of a pruritic, rash with photoexacerbated annular plaques along with arthralgias and bone pain. Compared to previous reports of photodistributed sarcoidosis, our case presented with annular plaques rather than papules, and there was no prior exposure to ionizing radiation. He was treated successfully with prednisone and hydroxychloroquine. It is important to include sarcoidosis in the differential of photodistributed dermatoses.

We read with great interest, the review paper by Lee et al. on the long term complications of Stevens-Johnson syndrome and toxic epidermal necrolysis. We would like to congratulate the authors on this important and excellent overview. This review demonstrated that SJS/TEN has a severe, chronic phase with major physical morbidities. We wish to raise awareness to the major emotional complications among survivors; as was found in our study published in the British Journal of Dermatology by Dodiuk-Gad et al. This article is protected by copyright. All rights reserved.