Causes and Treatment Outcomes of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in 82 Adult Patients.
10.3904/kjim.2012.27.2.203
- Author:
Hye In KIM
1
;
Shin Woo KIM
;
Ga Young PARK
;
Eu Gene KWON
;
Hyo Hoon KIM
;
Ju Young JEONG
;
Hyun Ha CHANG
;
Jong Myung LEE
;
Neung Su KIM
Author Information
1. Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea. ksw2kms@knu.ac.kr
- Publication Type:Original Article
- Keywords:
Stevens-Johnson syndrome;
Epidermal necrolysis, toxic;
Etiology;
Prognosis
- MeSH:
Adolescent;
Adult;
Aged;
Aged, 80 and over;
Chi-Square Distribution;
Epidermal Necrolysis, Toxic/diagnosis/*etiology/mortality/*therapy;
Female;
Humans;
Logistic Models;
Male;
Middle Aged;
Multivariate Analysis;
Odds Ratio;
Republic of Korea;
Risk Assessment;
Risk Factors;
Stevens-Johnson Syndrome/chemically induced/diagnosis/*etiology/mortality/*therapy;
Survival Analysis;
Treatment Outcome;
Young Adult
- From:The Korean Journal of Internal Medicine
2012;27(2):203-210
- CountryRepublic of Korea
- Language:English
-
Abstract:
BACKGROUND/AIMS: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are predominantly known as medication-induced diseases. However, at our institution, we have experienced more cases of non-drug-related SJS and TEN than expected. Therefore, we studied the difference between non-drug-related and drug-related SJS and TEN in terms of clinical characteristics and prognoses. METHODS: The etiologies, clinical characteristics, and treatment outcomes for 82 adult patients with SJS and TEN were retrospectively reviewed. RESULTS: A total of 71 patients (86.6%) were classified as having SJS, and the other 11 patients (13.4%) were classified as having TEN. Drug-related cases were more common (43, 52.4%) than non-drug-related cases (39, 47.6%). Anticonvulsants (12/82, 14.6%) and antibiotics (9/82, 11%) were the most common causative medications. Anemia (p = 0.017) and C-reactive protein of > or = 5 mg/dL (p = 0.026) were more common in the drug-related cases than in the non-drug-related cases. Intravenous steroid therapy was used as the main treatment regimen (70/82, 85.4%). Of the 82 patients, 8 (9.8%) died during the clinical course. A univariate analysis for mortality showed statistical significance for the following: kidney function abnormality, pneumonia, hemoglobin of < 10 g/dL, and combined underlying diseases. In a multivariate analysis, only pneumonia was statistically significant (odds ratio, 25.79; p = 0.009). CONCLUSIONS: Drugs were the most frequent cause of these diseases. However, non-drug-related causes also contributed to a significant proportion of cases. Physicians should keep this in mind when documenting patient history. In addition, early recognition and treatment may be important for better outcomes.
