Steven-Johnson syndrome and toxic epidermal necrolysis in Northern Sarawak between year 2011 and 2015: A retrospective review of causative agents and clinical outcome
Keywords:
Steven-Johnson syndrome, toxic epidermal necrolysis, drug reaction, steroids, intravenous immunoglobulinAbstract
Objective To determine the causes and treatment outcome of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Methods A retrospective review was conducted on SJS and TEN cases admitted to Miri General Hospital between year 2011 and 2015. Results Total of ten patients were admitted in five years period, nine cases of SJS and one case of TEN with highest number recorded in 2014 (4 cases). The commonest causative agent was allopurinol (30%). Among the ten cases, 7 patients were given steroids, 1 patient given intravenous immunoglobulin (IVIG), 2 patients given both steroids and IVIG. There was a case mortality from SJS secondary to allopurinol after 38 days of admission and patient was given only corticosteroids. Conclusion Allopurinol is the most common causative agent with mortality in Miri General Hospital. Allopurinol should be used judiciously. Combination therapy had tendency to reduce mortality rate in comparison with corticosteroid therapy alone. However, in view of small sample size, efficacy and superiority between treatment of corticosteroids and IVIG cannot be assessed.ÂReferences
Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis 2010;5:39
Kim HI et al. Causes and treatment outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in 82 adult patients. Korean J Intern Med 2012 Jun;27(2):203-10
Bastuji-Garin S, Rzany B, Stern RS et al. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol 1993;129:92–6
Fournier S, Bastuji-Garin S, Mentec H, Revuz J, Roujeau JC. Toxic epidermal necrolysis associated with Mycoplasma pneumoniae infection. Eur J Clin Microbiol Infect Dis 1995;14:558–9
Mulvey JM, Padowitz A, Lindley-Jones M, Nickels R. Mycoplasma pneumoniae associated with Stevens Johnson syndrome. Anaesth Intensive Care 2007;35:414–7
Schalock PC, Dinulos JG. Mycoplasma pneumoniae-induced Stevens-Johnson syndrome without skin lesions: fact or fiction? J Am Acad Dermatol 2005;52:312–5
Hsu DY et al. Morbidity and mortality of Steven-Johnson syndrome and toxic epidermal necrolysis in United States adults. Journal of Investigative Dermatology 2016 July;136(7): 1387-397
Halevy S, Ghilain PD, Mockenhaupt M et al. Allopurinol is the most common cause of Steven-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermato 2008;58(1):25-32
Hung SI, Chung WH, Liou LB et al. HLA-B5801 allele as genetic marker for severe cutaneous adverse reactions caused by allopurinol. Proc Natl Acad Sci USA 2005;102:4134-9
Kaniwa N, Saito Y, Aihara M. HLA-B locus in Japanese patients with anti-epileptics and allopurinol-related Stevens-Johnson syndrome and toxic epidermal necrolysis. Pharmacogenomics 2008;9:1617-22
Law EH, Leung M. Corticosteroids in Stevens–Johnson syndrome/toxic epidermal necrolysis: current evidence and implications for future research. Ann Pharmacol 2015;49: 335–42
Chen J, Wang B, Zeng Y, Xu H. High-dose intravenous immunoglobulins in the treatment of Stevens–Johnson syndrome and toxic epidermal necrolysis in Chinese patients: a retrospective study of 82 cases. Eur J Derm 2010;20:743–7
Tripathi A, Ditto AM, Grammer LC, Greenberger PA, McGrath KG, Zeiss CR, et al. Corticosteroid therapy in an additional 13 cases of Stevens–Johnson syndrome: a total series of 67 cases. Allergy Asthma Proc 2000;21:101–5
Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens–Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol 2007;87:144–8
Hirahara K, Kano Y, Sato Y, Horie C, Okazaki A, Ishida T, et al. Methylprednisolone pulse therapy for Stevens–Johnson syndrome/toxic epidermal necrolysis: clinical evaluation and analysis of biomarkers. J Am Acad Dermatol 2013;69:496–8
Yang Y, Xu J, Li F, Zhu X. Combination therapy of intravenous immunoglobulin and corticosteroid treatment in the treatment of toxic epidermal necrolysis and Steven-Johnson syndrome: a retrospective comparative study in China. Int J Dermatol 2009 Oct;48(10):1122-8
