Document Type : Case Report
Author
Department of Physiotherapy, Sri Devaraj Urs Academy of Higher Education and Research, Tamaka, Kolar, Karnatak 563103
Abstract
Background: Stevens-Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare but severe dermatological disorders. Their limited prevalence contributes to low awareness among physical therapists, which may lead to suboptimal rehabilitation and complications from immobility.
Methods: This report describes the physical therapy management of a 20-year-old female with SJS admitted to a rural tertiary care hospital in India. Physical therapy interventions were initiated early and progressed through functional task-based mobilization. Assessments were conducted at baseline, on the 7th and 20th days of admission, and at 1-month follow-up.
Results: Marked functional gains were observed, especially after the 7th day. Improvements were documented in the Intensive Care Unit Mobility Scale (IMS), Functional Status Score for the ICU (FSS-ICU), Barthel Index, and joint range of motion. Early mobilization contributed to reduced musculoskeletal and pulmonary complications, promoting faster recovery and shorter hospital stay.
Conclusion: This case highlights the importance of early, tailored physical therapy in SJS rehabilitation. Interdisciplinary collaboration and functional-task–oriented mobilization are essential to optimize outcomes, reduce morbidity, and enhance overall management of SJS.
Keywords
- Moshfeghi M, Mandler HD. Ciprofloxacin-induced toxic epidermal necrolysis. [No journal name provided]; [No year];[No volume]:3.
- McGee T, Munster A. Toxic epidermal necrolysis syndrome: mortality rate reduced with early referral to regional burn center. Plast Reconstr Surg. 1998;102:1018–22.
- Roujeau JC, Stern RS. Drug-induced severe skin reactions. Incidence, management and prevention. Drug Saf. 1994;10(6):408–17. [PubMed citation for https://pubmed.ncbi.nlm.nih.gov/8527020/]
- Lyell A. A new eruptive fever associated with stomatitis and ophthalmia: report of two cases in children. Am J Dis Child. 1956;91(1):1–7. Available from: https://jamanetwork.com/journals/jamapediatrics/article-abstract/1173827
- Smelik M. Stevens-Johnson syndrome: a case study. Perm J. 2002;6:29–31.
- Hutchinson JK, Gurwood AS. Iatrogenically induced Stevens-Johnson syndrome after a car accident. Optom Vis Sci. 2011;82:9–14.
- Downey A, Jackson C, Harun N, Cooper A. Toxic epidermal necrolysis: review of pathogenesis and management. J Am Acad Dermatol. 2012;66(6):995–1003.
- McCullough M, Burg M, Lin E, Peng D, Garner W. Steven Johnson syndrome and toxic epidermal necrolysis in a burn unit: a 15-year experience. Burns. 2017;43(1):200–5.
- McDonald K, Johnson B, Prasad JK, Thomson PD. Rehabilitative considerations for patients with severe Stevens-Johnson syndrome or toxic epidermal necrolysis: a case report. J Burn Care Rehabil. 1989;10:167–71.
- ISBI Practice Guidelines Committee; Advisory Subcommittee; Steering Subcommittee. ISBI practice guidelines for burn care, part 2. Burns. 2018;44(7):1617–706.
- Schmitt MA, French L, Kalil ET. How soon is safe? Ambulation of the patient with burns after lower-extremity skin grafting. J Burn Care Rehabil. 1991;12:33–7.
- Taylor S, Manning S, Quarles J. A multidisciplinary approach to early mobilization of patients with burns. Crit Care Nurs Q. 2013;36(1):56–62.
- de Figueiredo TB, Utsunomiya KF, de Oliveira AMRR, Pires-Neto RC, Tanaka C. Mobilization practices for patients with burn injury in critical care. Burns. 2020;46(2):314–21.
- Grube BJ, Engrav LH, Heimbach DM. Early ambulation and discharge in 100 patients with burns of the foot treated by grafts. J Trauma. 1992;33(5):662–4.
- Liu C, Shiroy DM, Jones LY, Clark DO. Systematic review of functional training on muscle strength, physical functioning, and activities of daily living in older adults. Eur Rev Aging Phys Act. 2014;11:95–106.
- Haber J, Hopman W, Gomez M, Cartotto R. Late outcomes in adult survivors of toxic epidermal necrolysis after treatment in a burn center. J Burn Care Rehabil. 2005;26(1):33–41.
- Tipping CJ, Bailey MJ, Bellomo R, Berney S, Buhr H, Denehy L, et al. The ICU Mobility Scale has construct and predictive validity and is responsive: a multicenter observational study. Ann Am Thorac Soc. 2016;13(6):887–93.
- Huang M, Chan KS, Zanni JM, Parry SM, Neto S-CGB, Neto JAA, et al. Functional status score for the intensive care unit (FSS-ICU): an international clinimetric analysis of validity, responsiveness, and minimal important difference. Crit Care Med. 2016;44(12):e1155–64.
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