Stevens-Johnson syndrome (SJS) is a rare yet serious skin disorder in which the skin blisters and the top layer of affected skin sheds. The blisters are extremely painful and often spread to orifices or openings in the human body. SJS is usually a reaction to a medication or is caused by an infection. Proving the causation of SJS is difficult, so it is important to have attorneys that have years of experience and knowledge of the complexity of Stevens-Johnson syndrome.
The Minnesota Stevens-Johnson syndrome attorneys at GoldenbergLaw have the experience, resources, and compassion to successfully handle your case. We will vigorously fight for you and your family to recover the compensation you need to deal with the dramatic effects on your life, and we will help you get the treatment you need to rehabilitate to the best of your ability.
Case Quick Facts
What Is Stevens-Johnson Syndrome?
Stevens-Johnson Syndrome (SJS) is a severe skin condition which can potentially cause burn-like symptoms and even death. It is one of the most serious adverse reactions to certain medications. An even more severe form of the condition is called Toxic Epidermal Necrolysis (TEN).
GoldenbergLaw is currently investigating cases where an individual has developed Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis due to a failure of medical practitioners to follow the dosing or titration instructions of the manufacturer.
Overview of SJS/TEN
Stevens-Johnson Syndrome (SJS) is a severe skin condition that may start out feeling like the flu, but is often followed by a skin rash and skin pain similar to a burn. TEN is an even more serious version of the condition and covers 30% or more of the body. This condition impacts the skin and mucous membranes and can result in skin peeling and blistering in sheets. This leaves raw, unprotected flesh which is extraordinarily painful. SJS/TEN can be fatal and is considered a medical emergency.
Other names for SJS/TEN include Lyell’s syndrome, SJS/TEN spectrum, drug-induced SJS, mycoplasma-included SJS, and susceptibility to severe cutaneous adverse reaction.
There can be even more risks in developing SJS or TEN in children under 18 years old. Most people that develop SJS or TEN will end up in intensive care or a hospital burn unit for weeks. The pain that a person incurs with SJS or TEN has been described by our clients as “unbearable.” Additionally, many people develop serious permanent damage to eyes, tear ducts, mouth, anus, genital tract or other affected parts of their bodies.
Symptoms of Stevens-Johnson Syndrome
Because Stevens-Johnson Syndrome is so rare, it is not always easy to identify. Symptoms of SJS include:
- unexplained widespread skin pain
- unexplained rash that spreads
- blisters on skin and/or orifice
Sometimes, an individual experiences flu-like symptoms several days before a rash appears.
SJS is a severe disorder that requires immediate medical attention. An individual with SJS may experience high medical expenses, lost wages, and a diminished quality of life.
Prescribing Medications that Can Cause SJS
Stevens-Johnson Syndrome can be caused by certain medications including anti-epileptic drugs, antipsychotics, and antibiotics. One such drug strongly linked to causing SJS is Lamictal, one of the most popular antipsychotic medications in the United States. In 2010, an FDA black-box warning was added to Lamictal which is one of the most stringent FDA warnings that can be added to medications. The black-box warning relays that Lamcital can cause severe adverse skin reactions such as Stevens-Johnson Syndrome, Dress Syndrome, and Toxic Epidermal Necrolysis. Furthermore, over the years, several studies have confirmed that these specific medications are strongly linked to causing SJS.
Prescribing doctors or nurse practitioners should be cautious when prescribing medications linked to causing SJS. The manufacturers of these drugs provide explicit instructions on risks, dosing and titration (how fast to build up the drug in the patient’s system). Increasing the dosing or titration may increase the risks-especially for minors.
Prescribers must also inform their patients of the severe risks associated with taking the drug and the need to immediately report any symptoms of flu or rash so the medication may be stopped immediately. A failure to do so may result in increasing the risks for the patient.
In spite of these duties to their patients, there are unfortunately occasions when prescribing doctors have failed to adequately prescribe, dose or warn of the risk of SJS when putting their patients on medication. This medical oversight can and has resulted in patients developing SJS or TENS, failing to recognize the symptoms in time, and the patients sustaining severe, traumatic, and life-threatening reactions.
What Types of Medications Can Cause SJS/TEN?
What Types of Medications Can Cause SJS/TEN?
Types of Medications that can cause SJS/TEN include:
- Antibacterial sulfa drugs
- Anti-epileptic drugs, anticonvulsants, antipsychotics
- Gout and kidney stone treatment
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Antibacterial sulfonamides
- HIV/AIDS treatment drugs
- Pain relievers
- Meloxican and Piroxicam
- Sulfa antibiotics
The most serious complication of SJS/TEN is death. The fatality rate for SJS cases is approximately 10 percent, and 50 percent for TEN cases. Secondary skin conditions associated with SJS/TENS such as cellulitis may lead to further problems such as blood poisoning (sepsis).
SJS and TEN causes the skin to peel off in sheets. This leaves large, raw, painful areas of exposed flesh.The loss of skin allows fluids and salts to ooze from the raw, painful areas which can easily become infected.
Treating SJS or TENS requires hospitalization and many people end up in intensive care or a burn unit of a hospital undergoing extensive therapy and utilizing the most powerful drugs to reduce pain.
Additional complications include:
- Lungs (Pneumonia)
- Heart (Myocarditis)
- Kidneys (nephritis)
- Liver (Hepatitis)
- Esophagus (Esophageal stricture)
- Eyes (rash, irritation, dry eyes, corneal ulceration, uveitis, blindness)
- Reproductive organs (vaginal stenosis and scarring of the penis)
- Anal damage to mucus membranes
Medical professionals and Pharmacists/Pharmacies.
According to Pharmacy Times, the black box warning on Lamictal warning of the risk of SJS is one of the top ten black box warnings of which medical professionals and pharmacies should be aware when prescribing and/or dispensing such medication. SJS is a horrific, life-threatening condition, and the risk of developing such a severe illness must be taken into consideration by medical professionals and pharmacists when prescribing or dispensing a drug. Furthermore, this risk must be communicated to the patient. If a prescriber or a pharmacist allows a drug to be dosed or titrated beyond what is recommended, they are increasing the serious risk to the patient and the patient should be informed of this.
Unfortunately, in spite of it being well known that certain medications can cause SJS, medical professionals are often found to be unaware of the link or the risks and fail to inform their patients about the risk for developing SJS. This avoidable oversight can and has caused substantial harm to patients.
Lamictal (lamotrigine) is an anti-epileptic medication also known as an anticonvulsant. The drug is commonly used to treat epileptic seizures in adults or children and to delay mood episodes in patients with bipolar disorder (manic depression). The medication is available as an immediate-release drug and extended-release Lamictal XR which is only available for use in patients above the age of 13. This is a highly prescribed drug and children are more vulnerable than adults to develop SJS or TEN from this medication.
GoldenbergLaw Can Help
GoldenbergLaw is currently representing both children and adults diagnosed with SJS/TEN due to improper dosing of medications. We represent drug victims around the country. Most people do not even know when their doctor or practitioner has exceeded the manufacturer’s recommended dosing instructions. Contact our Minnesota Drug and Medical Malpractice attorneys today for a free case consultation. We have over 30 years of experience obtaining justice for victims of medical negligence. Let us deliver the Gold standard advocacy you deserve.
Timeline of SJS Symptoms
If SJS/TEN was caused by a medication, symptoms usually appear about 1-3 weeks after a person started taking the medication.
1-3 days before the rash develops, patients usually experience flu-like symptoms such as fever, sore throat and mouth, fatigue, burning eyes, body aches, and cough.
After the flu symptoms, unexplained and widespread skin pain usually occurs followed by a red or purplish rash that spreads throughout the body. The rash is followed by blisters and sores appearing on the skin— usually starting with the face and chest. The blisters then spread to the body’s other mucous membranes (thin, moist tissues that line the body’s cavities) in the mouth, throat, eyes, digestive tract genitals and anus.
Early symptoms of mucous membrane involvement may include light sensitivity, itching or burning of the eyes, and pain when swallowing. As the condition continues to progress, eye symptoms may include pain, severe conjunctivitis, discharge, iritis, and corneal blisters. Damage to the eye can also become long-term, leading to vision loss. Mouth and throat injuries may include painful blisters, trouble swallowing and breathing. Symptoms of genital involvement may include inflammation of the urethra, vaginitis, painful blisters and difficulty urinating. Gastrointestinal symptoms may include diarrhea, black or tarry stools and other complications.
Symptoms usually persist and worsen for up to two weeks before the skin and mucous membranes begin to heal themselves–although it may take many weeks or even months to fully recover. The remaining attached skin may peel and nails may fall off during this time. Once the top layer of the affected skin dies, it sheds and then begins to heal.
After healing from SJS/TEN, the skin regrows; however, it may grow back in uneven colors and scarring may occur. Other permanent issues with eyes, organs and tissue may persist.
SJS In the News
In April 2015, Massachusetts’ Supreme Judicial Court affirmed a $63 million verdict against Children’s Motrin’s manufacturers McNeil-PPC Inc. and its parent company Johnson & Johnson. A 7-year-old, Samantha Reckis, took Children’s Motrin after contracting a fever. Samantha then developed toxic epidermal necrolysis (TEN) which caused her to lose 90% of her skin, 80% of her lung capacity, and her vision–conditions which resulted in her needing to undergo almost 100 surgeries. Samantha and her parents sued the defendants over their failure to provide adequate warnings about the risk associated with Children’s Motrin–specifically, the need to provide a warning that using Children’s Motrin could result in a life-threatening condition. In 2003, when Samantha took the Children’s Motrin for her fever, the warning advised users to stop using it if an allergic reaction occurred, but the warning failed to mention that TEN or its symptoms could be signs of a life-threatening condition.
In June 2015, Courtney McBride sued the Houston County Health Care Authority, two doctors, and two correctional officers for medical malpractice after developing SJS and TEN after being allegedly over prescribed Lamictal during a hospital visit. Courtney developed a severe case of SJS and TEN which resulted in her having a rash on over 99% of her body. The prescribing doctor warned of the risks associated with medication, however, instructed the patient to only stop taking it after consulting a physician first. The patient was subsequently imprisoned where she developed SJS symptoms. She alleged that officers refused to allow her to seek medical attention in a timely manner. This complicated case involved qualified immunity concepts associated with the officers, who were eventually dismissed from the case and then later added back in after appeal to the lower court dismissal. The case did proceed to trial against the prescribing physician, however, in light of the facts, the jury found in favor of the physician. Later, the City and officers settled with the plaintiff’s estate. Ms. McBride passed away in 2016 prior to resolution.
After the FDA found 107 cases of the severe skin reactions from the use of Acetaminophen between 1969 and 2012 in which 12 people died and 67 were hospitalized, the FDA issued a warning that Acetaminophen (commonly in Tylenol) can cause SJS and TEN. The FDA is now taking steps to add warnings about skin reactions to over-the-counter labels of medications that contain acetaminophen and require prescription medications to include the same warnings.
In September 2010, Karen Bartlett was awarded $21 million by a New Hampshire jury after suffering a severe skin reaction from a generic version of anti-inflammatory drug Clinoril (marketed as Sulindac). Karen took Sulindac in 2005 to treat her shoulder pain, but two weeks later she showed signs of a skin reaction around her face and eyes and was soon admitted to a hospital. She was in the hospital for 112 days and suffered damage to 65% of her skin. In her lawsuit, she accused Mutual Pharmaceutical Co. of failing to adequately warn about the life-threatening side effects of the medication. In 2011, the U.S. Supreme Court held that generic drug manufacturers could not be held liable for defective (incomplete) warning labels that accompany their products. In June 2013, the United States Supreme Court overturned the Court of Appeals’ decision that the generic version of a drug’s manufacturer could not be held liable for injuries caused by a drug’s defective design. As a result of these rulings, Bartlett’s lawsuit was thrown out. However, in response the FDA proposed changes to help ensure that generic manufacturers warn consumers about the risks associated with using their medications.
GoldenbergLaw offers free consultations to those who believe they may have a Stevens-Johnson syndrome Lawsuit. Don’t hesitate to reach out to us: there is no charge and there is no obligation.
EuroSCAR Study on Allopurinol Causing SJS/TEN
In a multinational case study, EuroSCAR reported by ResearchGate indicated that the gout, kidney stone, and uric treatment drug Allopurinol was the drug most frequently associated with causing SJS/TEN. The study revealed that the use of Allopurinol has increased since previous case-controlled European study and daily doses equal to or greater than 200 mg were associated with a higher risk of SJS/TEN compared to lower doses. The study concluded that the occurrence of allopurinol-associated SJS/TEN has increased potentially due to the increased use and dosages of the drug.
Singapore General Hospital Study of Drug-Induced SJS/TEN
A 6-year retrospective study conducted by the Department of Plastic Surgery at the Singapore General Hospital reviewed 23 patients with drug-induced SJS/TEN. The study determined that the most common causes for the condition were anticonvulsants and traditional medication. Complications from SJS/TEN caused by drugs were commonly ocular and sepsis. The average mortality rate for SJS/TEN patients in the study was 25% for patients with ocular complications and 10% for patients without ocular complications.
Who Is Most at Risk for SJS/TEN?
Many SJS/TEN cases occur in children and adults under 30 years old; however, cases can occur in other age groups, especially the elderly. SJS/TEN cases are more common in females than males.
People with the following conditions are at a greater risk of contracting SJS/TEN:
- Bone marrow transplant recipients
- Systemic lupus erythematosus
- Human immunodeficiency virus (HIV)
- Chronic diseases of joints and connective tissue
- Weakened immune system
- Family history of SJS/TEN
- Personal history of SJS/TEN
What are the Causes of SJS/TEN?
SJS/TEN can be caused by infections, vaccinations, and side effects from medications. In children, SJS is commonly caused by infections. However, in adults, SJS is most commonly caused by an adverse reaction to a medication.
What Types of Infections Can Cause SJS/TEN?
Infections that can Cause SJS/TEN:
- Herpes (simplex or zoster)
What are the Most Common Causes of SJS/TEN in Children?
Most Common Causes of SJS/TEN in Children:
- Herpes (simplex or zoster)
- Epstein-Barr virus
Do I Have A Stevens-Johnson Syndrome Case?
If you have been diagnosed with SJS/TEN due to an overprescription or misdosing of medication, you may have a case against the prescribing authority. Contact the Stevens-Johnson syndrome lawyers at GoldenbergLaw today for a free consultation.