Steven-Johnson syndrome and toxic epidermal necrolysis in Northern Sarawak between year 2011 and 2015: A retrospective review of causative agents and clinical outcome
DOI:
https://doi.org/10.66344/jpad.v27i3.713Keywords:
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.
References
1. Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39
2. Kim HI, Kim SW, Park GY, Kwon EG, Kim HH, Jeong JY et al. Causes and treatment outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in 82 adult patients. Korean J Intern Med. 2012;27:203-10.
3. Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of cases of toxic epidermal necrolysis, Stevens-Johnson syndrome, and erythema multiforme. Arch Dermatol. 1993;129:92-6.
4. 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.
5. Mulvey JM, Padowitz A, Lindley-Jones M, Nickels R. Mycoplasma pneumoniae associated with Stevens-Johnson syndrome. Anaesth Intensive Care. 2007;35:414-7.
6. Schalock PC, Dinulos JG. Mycoplasma pneumoniae-induced Stevens-Johnson syndrome without skin lesions: fact or fiction? J Am Acad Dermatol. 2005;52:312-5.
7. Hsu DY, Brieva J, Silverberg NB, Silverberg JI. Morbidity and mortality of Steven-Johnson syndrome and toxic epidermal necrolysis in United States adults. J Invest Dermatol. 2016;136:1387-97.
8. Halevy S, Ghilain PD, Mockenhaupt M, Fagot JP, Bouwes Bavinck JN, Sidoroff A et al. Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. J Am Acad Dermatol. 2008;58:25-32.
9. Hung SI, Chung WH, Liou LB, Chu CC, Lin M, Huang HP 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.
10. 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.
11. 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.
12. 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.
13. 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.
14. Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol. 2007;87:144-8.
15. 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
16. 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;48:1122-8.
Downloads
Published
Issue
Section
License
Copyright (c) 2018 Kee Tat Lee, Teh Yeon Chiat, Yong Kar Ying, Pubalan A/L Muniandy
This work is licensed under a Creative Commons Attribution 4.0 International License.
Submission declaration
Authors retain the copyright to their work and grant the 'Journal of Pakistan Association of Dermatologists (JPAD)' the right of first publication under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This license allows others to share, adapt, and reuse the work for any purpose, including commercial use, as long as appropriate credit is given to the original authors and the journal.
By submitting a manuscript, authors confirm that the work has not been published previously (except as an abstract, lecture, or academic thesis), is not under review elsewhere, and has been approved by all authors and relevant authorities. Once accepted, the article will be openly accessible under the CC BY 4.0 license, ensuring wide dissemination and reuse with proper attribution.
