STEVENS-JOHNSON SYNDROME PRESENTING AS INTRAVENOUS LINE SEPSIS

A 25-year-old Hispanic female with insulin dependent diabetes mellitus (IDDM) and endstage renal disease on chronic hemodialysis was hospita lized with paroxysms of fever and chills for a day. A day after starti ng piperacillin for presumed intravascular line infection, she develop ed a maculopapular dermatitis and abnormal liver function tests, at wh ich point the drug was discontinued. However the rash persisted for 10 days, after which it progressively worsened. She continued to have hi gh fevers, abnormal liver function rests, and marked leukocytosis, des pite multiple negative cultures and other nondiagnostic examinations. She was treated as a patient with sepsis of unknown etiology and recei ved multiple antibiotics on an empiric basis without response. A diagn osis of Stevens-Johnson syndrome was then made based on the triad of c utaneous dermatitis, mucosal, and hepatic involvement. She received hi gh dose corticosteroids and her fever, dermatitis, mucosal lesions, le ukocytosis, and abnormal liver function tests improved dramatically.