Mucosal-Dominant Stevens-Johnson Syndrome Presenting as Hemorrhagic Glossitis in a Multimorbid Patient: A Diagnostic Challenge

Abstract

Stevens-Johnson syndrome (SJS) is a rare but potentially life-threatening mucocutaneous reaction, most often triggered by medications or infections. While classical SJS involves cutaneous and mucosal surfaces, atypical presentations with isolated mucosal involvement are rarely reported and frequently under-recognized. We present a diagnostically challenging case of mucosal-predominant SJS manifesting as severe hemorrhagic glossitis without cutaneous lesions in a 60-year-old male with multimorbidity, including recurrent strokes, coronary artery disease, chronic kidney disease, and type 2 diabetes mellitus. His condition progressed despite initial antimicrobial treatment but improved significantly with systemic corticosteroids. This case underscores the importance of considering mucosal SJS in the differential diagnosis of severe oral mucositis, particularly in multimorbid patients. It highlights the utility of immunosuppressive therapy when the diagnosis is suspected.