J Pediatr Adolesc Gynecol (2002) 15:151-152 © 2002 North American Society for Pediatric and Adolescent Gynecology 1083-3188/02/$22.00 Published by Elsevier Science Inc. PII S1083-3188(02)00146-8 Original Studies Vaginal Adhesions Caused by Stevens-Johnson Syndrome Roger Hart, MRCOG, Catherine Minto, MB ChB, and Sarah Creighton, MD, MRCOG Reproductive Medicine Unit, Elizabeth Garrett Anderson Hospital, University College Hospitals, London, United Kingdom Abstract. Stevens-Johnson syndrome is a rare, life-threatening condition characterized by epidermal necrosis and involvement of the mucosal surfaces. We report a case of Stevens-Johnson syndrome with vaginal involvement in an 11-yr-old girl who was treated conservatively in the acute stage of the disease. Af- ter recovery from the profound systemic upset, she underwent vaginoscopy, which demonstrated some adhesions, which were divided. We recommend that all patients with Stevens- Johnson syndrome with vaginal involvement undergo routine follow-up to evaluate possible adhesions. Key Words. Stevens-Johnson syndrome—Vaginal adhesions—Vaginoscopy Introduction Stevens-Johnson syndrome is a life-threatening muco- cutaneus condition usually precipitated by a drug. It is rare, with an incidence of up to 6 cases per million population per year. 1 The condition is characterized by the rapid development of widespread epidermal ne- crosis. The primary lesions are usually irregular target lesions or flat purpuric macules involving the trunk, face, and proximal limbs. The cutaneous necrosis is associated with involvement of the mucosal surfaces and severe constitutional disturbance. 2 In the majority of cases of patients presenting with Stevens-Johnson syndrome, sulfonamides, anticonvul- sant agents, nonsteroidal anti-inflammatory drugs, or al- lopurinol are implicated. 1 Management consists of stopping all medication and supportive treatment in ei- ther a burn or intensive care unit. The supportive therapy consists of rehydration, reducing heat loss, topical anti- septic preparations, and infection survelliance. Nasogas- tric feeding may be required. Prophylactic use of antibiotics is controversial, as is the routine administra- tion of steroids. 2 Death occurs in less than 5% of cases and is usually due to sepsis. However, scarring of the mucus membranes can lead to strictures of the esoph- ageal, tracheal, genital, or anal mucosa. 3 We describe a case of a young girl presenting after the acute episode of Stevens-Johnson syndrome with intravaginal adhesions. Case Report An 11-yr-old girl presented with Stevens-Johnson syndrome secondary to the administration of a cepha- losporin prescribed to treat a chest infection two weeks previously. She had not been prescribed a cephalosporin before but had demonstrated a marked reaction to penicillin several years previously, with a skin rash and mild ulceration of the mouth. In this episode she had a marked irregular purpuric macular rash involving mainly her trunk and limbs with conjunctivitis and oral, vulval, and vaginal ulceration. In the acute phase of the disease she was treated with acyclovir and intravenous hydrocortisone. This was subsequently changed to oral prednisolone, acyclovir, and topical Timovate cream (Glaxo-Wellcome, Mid- dlesex, UK) and liquid paraffin cream until the lesions healed. The lesions took approximately one month to completely heal. Due to the marked vulvovaginal ulcer- ation during the acute phase of her disease, it was felt prudent to exclude any vaginal adhesions by perform- ing examination under anesthesia and vaginoscopy ex- actly six months after the acute episode. At the time of examination under anesthesia, there were visible fine adhesions at the introitus. There were no other introital abnormalities, and she had not yet started to menstruate and was appropriately Tanner staged for her age. Using a 2-mm pediatric cystoscope (Karl Storz, Tuttlingen, Germany) video vaginoscopy was performed using saline as the distension medium. Approximately 2 cm beyond the introitus there were sev- eral small band-like adhesions (Fig. 1). These fine adhe- sions could be easily broken down with the cystoscope. No bleeding occurred, and a topical local anesthetic gel was applied to the vagina (Instillagel, CliniFlex, High Address reprint requests to: Mr. Roger Hart, Reproductive Medi- cine Unit, Elizabeth Garrett Anderson Hospital, Huntley Street, London WC1E 6DH, U.K.; E-mail: roger_hart1@yahoo.com