Departments: Response to Letter
Thank you for your interest in our case.1 Although our abstract and case report indicate that we believed the initial diagnosis of Stevens-Johnson syndrome to be inaccurate, our title was misleading. We have retracted and resubmitted our article to ensure the integrity of the medical literature (see the Editor's Note below).
We would like to share with you further details on the histopathology of this case. Our patient initially presented to a Japanese hospital. From the limited documentation that we received with her transfer, it was noted that Stevens-Johnson syndrome was their diagnosis based on her presentation. Our team unfortunately was not present for this initial occurrence, nor do we have any photo documentation of the skin lesions.
Initial skin biopsies were reviewed by the Defense Health Agency Joint Pathology Center and were noted to show superficial perivascular lymphocytic infiltrate with occasional scattered eosinophils and splitting and the dermal-epidermal junction with associated apoptotic keratinocytes. The findings were felt to be most in keeping with erythema multiforme. Repeat biopsy at our institution demonstrated lichenoid dermatitis.
As the patient’s condition progressed, the initial diagnosis was doubted and then disproved after an intradermal progesterone test was administered. We would like to clarify that it was at this point that she was referred to our gynecology department for management of autoimmune progesterone dermatitis. The main objective of our article was to highlight a severe case of this disease along with its difficult management and treatment course. We in no way intended to be misleading or to imply that Stevens-Johnson syndrome is a manifestation of autoimmune progesterone dermatitis.
1. Drayer SM, Laufer LR, Farrell ME. Autoimmune progesterone dermatitis presenting as Stevens-Johnson syndrome. Obstet Gynecol 2017;130:881–4.