Stevens-Johnson syndrome (SJS) is a rare systemic disorder with significant mortality and in three cases we assessed current treatment.

We present three separate cases in which patients presented with distinct dermatologic manifestations of SJS. Patient A presented with skin lesions that were urticarial and treated initially with prednisone. Patient B presented with fever, lethargy, confluent rash, and desquamation. Patient C presented with target lesions and stomatitis.

Each patient had different presentations making the diagnosis difficult. Patient A eventually developed oral pharyngeal swelling and ulcers. A diagnosis of SJS was made and the patient improved after intravenous immunoglobulin (IVIG) therapy. Patient B had dermatitis and desquamation consistent with SJS. The inciting agent was determined to be phenytoin and was discontinued. Patient C also was initially diagnosed with SJS. This patient required treatment with IVIG and management in an intensive burn unit.

The diagnosis of SJS can be obscure in cases where the patient only presents with rash. However, once the diagnosis is confirmed clinically, IVIG may provide clinical benefit. More severe cases evidenced by patient C may benefit from transfer to an acute burn unit.