Case Study: The Stevens-Johnson Syndrome

This is regarding an incident at Mercy Hospital of Buffalo with a Dr. Darren Huffman, on May 11th, 2018 at approximately 4pm-6pm. I went through the double doors and entered the first room in the E.R to the right. I believe it is known as the triage room. I came to Mercy Hospital because of a hand injury I received at work. I brought a piece of paper from workers compensation with me because of the injury. I just switched insurance providers and never picked a primary care physician. My hand was and still is swollen since the injury happened on 12/24/2017, and figured going to the nearest hospital would be the quickest way to get it checked out before I go to a specialist on the 17th of May.

On 9/23/16 I met with Mr. Russell at the Covenant Occupational Medicine. Mr. Russell said his pain level is at a 1 to 2 now. He is able to tolerate sitting, standing and walking more since starting physical therapy. He reports he is doing a home exercise program also. Dr. Eckstein said he would increase his work restrictions. He would like him to have 2 more weeks of physical therapy. He hopes at the next appointment to be released.

HISTORY AND PHYSICAL EXAMINATION_______________________ Patient Name: Chapman Robert Kinsey Patient ID: 110589 Room No.: 322-B Date of Admission: 23 February ---Admitting Physician: Martha C. Eaton, MD, Geriatrics Chief Complaint: Admitted from Dr. Max Hirsch’s office due to deep ulcer on left toe. Admitting Diagnoses 1. Severe peripheral vascular disease, status post deep ulcer on left toe. Rule out thrombolysis. The patient was admitted to a regular floor. Condition is serious. 2. ALLERGY TO PENICILLIN, which puts patient into anaphylactic shock. 3. Continue with home medications. DETAILS OF PRESENT ILLNESS: Mr. Kinsey is an 87-year-old white gentleman with history of (1) Chronic atrial fibrillation, on Coumadin. (2) Chronic deafness,

PROCEDURE: The patient was placed in the supine position on the operating room table, where her right hand and forearm were prepped with Betadine and draped in a sterile fashion. We infiltrated the thenar crease area with 1% Xylocaine, and once adequate anesthesia had been achieved, we exsanguinated the hand and forearm with an Esmarch bandage. We then created a longitudinal incision just at the ulnar aspect of the thenar crease and carried the dissection down through the subcutaneous tissue. We identified the transverse carpal

Per the medical report by Dr. Landauer dated 11/18/2015, the patient presents reporting that therapy helped his bilateral shoulder and hand pain, but the therapy ended 2 months ago.

Per medical report dated 10/26/15 by Dr. Parsioon, the patient was initially seen on 9/14/15 for evaluation and treatment of cervical pain. At that time, he had neck pain without radiculopathy and bilateral hand tingling. IW stated that physical therapy made his neck pain increase and he wanted to make sure that it is okay to continue this. His chief complaint is pain in his neck radiating to the right shoulder and arm. He states the only time he gets the tingling sensation in the hand is

DIAGNOSIS: Strain of muscle, fascia, and tendon at neck level; Carpal tunnel syndrome, unspecified right limb,;Carpal tunnel syndrome, unspecified left limb; Status post left carpal tunnel release; and Adhesive capsulitis of right shoulder (M75.01).

I spoke with Mr. Sutter several times since 3/2/17. Mr. Sutter moved his medical appointment from 2/23/17 to 3/2/17. I was not unable to attend nor was I able to find a co-worker to attend. I spoke with Dr. Olenyn’s office staff many times for updated scripts and next appointment time. Mr. Sutter has lymph edema to the right and left legs. He was supposed to elevated and also wears compression stocking. His legs are so big the stockings cut in. Dr. Olenyn told Mr. Sutter he must get the swelling down because that will affect the healing of the fractures. He is at high risk for infections from open skin. Some of the bones are healing but not all. Mr. Sutter continues to use a bone stimulator daily. I have spoken with Mr. Sutter and

DOI: 2/25/2014. Patient is a 23 year-old male laborer who sustained a work-related injury to his right hand index finger, middle finger, and ring finger when they got caught in the mixer paddle. As per OMNI entry, the patient underwent open reduction fixation on 3/4/2014 and another surgery for removal of pins, skin graft, and debridement on 06/2013.

The patient has been diagnosed with bilateral peripheral neuropathy. She has been seeing Kishori Somyreddy, MD. Dr. Somyreddy recommended physical therapy, which she is not sure it helped with the neuropathy, but she does think it helps with her chronic back pain and she is feeling better from that standpoint. She has not been able to stick with the physical therapy exercises as much of late, but does plan on getting back to that now that she is settled and feeling less stress with all that she needs to do.

Based on the medical report dated 03/31/16 by Dr. Schonwald, the patient reports pain in his low back, left lower extremity, right lower extremity, as well as in his left hand that originates at his left elbow and to his fingertips.

Johnson-Munson syndrome is a rare syndrome identified by missing abnormal vertebrae, fingers and toes and various deformities of the heart, lungs, intestines, pancreas and intestines. Ophanet a consortium of European partners defines a condition as rare. In the US population, less than 200,000 people can possibly be affected by Johnson Munson Syndrome or second type of Johnson Munson syndrome. (Orphanet 2015)

Mr. Jackson presents for above concerns. He was seen initially on 12/19/2016 for evaluation of facial irritation by nursing staff. He states he had been using a straight razor daily and had significant skin irritation along his neck, had been instructed to use warm compresses along with Calmoseptine and was instructed to not shave for three days and follow up thereafter. Skin lesions worsened and although he was instructed to shave on Monday, Wednesday, and Friday for a shaving profile. He was instructed to not shave his face until seen today. Additionally, he has had dry skin on his hands primarily with some cracking along the knuckles of the right hand. States he has been working at KP and has his hands in water for a good portion of the day. He had been using some hydrocortisone cream and has seen some improvement.

Stevens – Johnson syndrome (SJS) is a severe immune response-mediated hypersensitivity reaction to particular drugs or infections that causes rashes, sloughing of the skin, and the disruption of mucous membranes. This condition may affect abdomen, back, breasts, feet, gastrointestinal system, genitals, hands, head, immune system, knees, legs, lungs, neck, nose, reproductive system, respiratory system, urinary system and eyes.

After 2 weeks, a baseline should be able to be established sufficiently without putting any subgroup at risk of serious infection considering the preventative measures taken. A final CNS should be taken, along with final measurements, and all groups should be compared to see if any quantifiable differences can be noticed, such as the size of the wound, amount of necrosis surrounding the wound, and how many ppm’s of bacteria are present. This is a purely quantitative study. We should note anything the patient says about pain, but only to insist that they intimate this to the physician or