Stevens-Johnson syndrome presenting with massive oesophageal bleeding

Abstract

Stevens-Johnson syndrome (SJS) is a severe adverse drug reaction affecting the skin and mucosal membranes, characterised by lesions covering less than 10% of the body's surface. Although gastrointestinal (GI) complications are usually mild, severe GI involvement can be life-threatening. A woman in her 30s with end-stage renal disease developed sepsis from methicillin-sensitive Staphylococcus aureus After 15 days of hospitalisation and antibiotic treatment, she developed new skin lesions, followed by massive GI bleeding and haemodynamic instability. Oesophagogastroduodenoscopy revealed necrotic plaques and mucosal sloughing along the oesophagus. Skin biopsy results confirmed SJS. Despite intensive care and multiple blood transfusions, she required intravenous dexamethasone. The patient improved and was discharged after 6 weeks. SJS can lead to serious complications, including rare but potentially life-threatening GI involvement. Effective management involves drug withdrawal, intensive care, immunosuppression and symptomatic treatment.