(655) Can COVID Lead to Poorer Outcomes From Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis?

Introduction: The long-term effects of COVID-19 are numerous and non-specific. The Centers for Disease Control have described generalized, neurologic, pulmonary, and cardiovascular conditions. One of the non-specific symptoms can also be rash. We present four patients with previous history of COVID and unclear medication exposures presenting with SJS/TEN overlap and TEN to our unit. We aimed to determine if a history of COVID may lead to SJS or worsen outcomes for patients presenting with SJS.

Methods: Patients were identified using the Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted to the BICU between April 2021 to June 2022 were included. Demographics, length of stay (LOS), co-morbid conditions, and mortality were evaluated.

Results: There were 4 patients seen during this period. Two patients were female. Three patients were Black. The median age was 42 years (4-63). All patients survived. All patients required mechanical ventilation, median of 20 days (7-37). The average percentage of total body surface area involved was 48% (+/- 30%). Three patients had multi-system organ dysfunction with acute renal failure. The median SCORTEN was 3 (2-4). Four patients had acute respiratory distress syndrome (ARDS). One patient required extracorporeal membrane oxygenation. One patient had ibuprofen thirty days prior to presentation, one patient was exposed to vancomycin prior to rash, one patient had one dose of doxycycline 12 hours prior to rash, and one patient had sulfamethoxazole/trimethoprim exposure prior to rash. Two patients underwent skin substitute placement due to th e total body surface area affected.

Conclusions: Patients with a history of COVID may present with a rash that has a similar presentation to and biopsies consistent with SJS/TEN. In addition, patients with SJS/TEN with a history of COVID may have a more severe presentation characterized by ARDS and multi-system organ dysfunction. The lingering effects of COVID on the immune system may trigger worsening signs and symptoms in patients already at risk for devastating disease states due to an overwhelming inflammatory response to a dangerous skin condition in an already taxed immune system.