Korean J Med.  2017 Apr;92(2):171-176. 10.3904/kjm.2017.92.2.171.

Experience of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a Regional Hospital: 70 Cases in 7 Years

• Lee J
• Kim JW

• KMID: 2382657
• DOI: http://doi.org/10.3904/kjm.2017.92.2.171

Abstract

BACKGROUND/AIMS
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions that frequently result in fatal outcomes. We investigated cases of SJS and TEN in a regional hospital.
METHODS
From 2008 to 2014, SJS and TEN cases were enrolled retrospectively by allergy and dermatology specialists, and their clinical features and severity-of-illness score for TEN (SCORTEN) were assessed.
RESULTS
During the 7-year study period, 56 SJS and 14 TEN cases were recruited. The majority (71%) were 40-70 years of age (mean age of male and female patients, 55 and 54 years, respectively). Regarding drugs, anticonvulsants (42.8%) were the most frequently causative, followed by carbonic anhydrase inhibitors (20.0%), antimicrobials (15.7%), allopurinol (7.1%), and non-steroidal anti-inflammatory drugs (7.1%). No fatal case of SJS was seen. However, 7 of the 14 patients with TEN died (50%; mean age, 67 years; 1 of 5 [20%] males and 6 of 9 females [66.7%]). The mortality rate was reflected in the SCORTEN values. Vancomycin, allopurinol, methazolamide (two cases each) and megestrol (one case) were the causative drugs in the seven fatal TEN cases. Treatment modality did not affect the likelihood of death due to TEN.
CONCLUSIONS
The causative drugs of, and frequency of mortality due to, SJS and TEN should be recognized by physicians. Elderly females with TEN are at high risk of mortality. SCORTEN values reflect the mortality rate of TEN patients. Early recognition and proper management of SJS and TEN may reduce the mortality rate.

Keyword

Adverse drug reaction; Stevens-Johnson syndrome, Drug-induced; Toxic epidermal necrolysis; Mortality

MeSH Terms

Aged
Allopurinol
Anticonvulsants
Carbonic Anhydrase Inhibitors
Dermatology
Drug-Related Side Effects and Adverse Reactions
Fatal Outcome
Female
Humans
Hypersensitivity
Male
Megestrol
Methazolamide
Mortality
Retrospective Studies
Specialization
Stevens-Johnson Syndrome*
Vancomycin
Allopurinol
Anticonvulsants
Carbonic Anhydrase Inhibitors
Megestrol
Methazolamide
Vancomycin