Volume 25, Issue 4 (Avicenna Journal of Clinical Medicine-Winter 2019)                   Avicenna J Clin Med 2019, 25(4): 193-199 | Back to browse issues page


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Alirezaei P, Sobhan M R, Saadatmand A. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in Patients Admitted to Sina Hospital in Hamadan, Iran: A 16-year study. Avicenna J Clin Med 2019; 25 (4) :193-199
URL: http://sjh.umsha.ac.ir/article-1-1822-en.html
1- , Ali.s_umsha@yahoo.com
Abstract:   (10136 Views)
Background and Objective: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and potentially life-threatening reactions. In spite of the low prevalence of these conditions, they are of utmost significance due to their catastrophic complications and mortality. The SJS and TEN are mostly caused by a reaction to a drug; however, in some cases, they result from infections. The aim of this study was to investigate the epidemiologic, etiologic, and clinical characteristics of the patients admitted to Sina Hospital in Hamadan, Iran, due to SJS and TEN during a 16-year period.
Materials and Methods: This cross-sectional descriptive study was conducted on the patients with SJS and TEN admitted to Sina Hospital during the last 16 years (i.e., 2002-2018). The data analyzed in the present study included age, gender, causative drug, length of hospital stay, received treatment, and complications.
Results: A total of 47 patients, consisting of 21 males and 26 females, were investigated in this study. Out of the 47 patients, 34, 9, and 4 cases were diagnosed with SJS, TEN, and SJS/TEN overlap, respectively. Regarding the etiology of these conditions, 45 cases (95.7%) were drug-related, while the remaining 2 cases were caused by reasons other than drugs. The most common causative drugs were antimicrobials (36.1%), followed by antiepileptics (27.6%) and nonsteroidal anti-inflammatory drug (17 %). Furthermore, there one case caused by reaction to allopurinol, and another case resulted from reactions to rabies vaccine. The remaining cases were either non-drug related or multi-drug related. The most common complications were infections (21.2%), followed by ocular problems (19.1%) and gastrointestinal bleeding (2.1%).
Conclusion: As the findings indicated, antimicrobials were the most common causative drugs of SJS and TEN. The physicians should be aware of the clinical manifestations of SJS and TEN with regard to the severe complications of these conditions, including ocular damages, and their risk of mortality. Moreover, it is required to enhance public awareness regarding the avoidance of self-medication with antimicrobial drugs.
 
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Type of Study: Original | Subject: Dermatology

References
1. Letko E, Papaliodis DN, Papaliodis GN, Daoud YJ, Ahmed AR, Foster CS. Stevens-Johnson syndrome and toxic epidermal necrolysis: a review of the literature. Ann Allergy Asthma Immunol. 2005;94(4):419-36. PMID: 15875523 DOI: 10.1016/S1081-1206(10)61112-X
2. Schneider JA, Cohen PR. Stevens-Johnson syndrome and toxic epidermal necrolysis: a concise review with a comprehensive summary of therapeutic interventions emphasizing supportive measures. Adv Ther. 2017;34(6):1235-44. PMID: 28439852 DOI: 10.1007/s12325-017-0530-y
3. Bouvresse S, Valeyrie-Allanore L, Ortonne N, Konstantinou MP, Kardaun SH, Bagot M, et al. Toxic epidermal necrolysis, DRESS, AGEP: do overlap cases exist? Orphanet J Rare Dis. 2012;7:72. PMID: 23009177 DOI: 10.1186/1750-1172-7-72
4. Choon SE, Lai NM. An epidemiological and clinical analysis of cutaneous adverse drug reactions seen in a tertiary hospital in Johor, Malaysia. Indian J Dermatol Venereol Leprol. 2012;78(6):734-9. PMID: 23075643 DOI: 10.4103/0378-6323.102367
5. Saeed H, Mantagos IS, Chodosh J. Complications of Stevens-Johnson syndrome beyond the eye and skin. Burns. 2016;42(1):20-27. PMID: 25865527 DOI: 10.1016/j. burns.2015.03.012
6. Rzany B, Mockenhaupt M, Baur S, Schröder W, Stocker U, Mueller J, et al. Epidemiology of erythema exsudativum multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis in Germany (1990–1992): structure and results of a population-based registry. J Clin Epidemiol. 1996;49(7):769-73. PMID: 8691227
7. Hosaka H, Ohtoshi S, Nakada T, Iijima M. Erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis: frozen-section diagnosis. J Dermatol. 2010; 37(5):407-12. PMID: 20536645 DOI: 10.1111/j.1346-8138.2009.00746.x
8. Patel T, Barvaliya M, Sharma D, Tripathi C. A systematic review of the drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in Indian population. Indian J Dermatol Venereol Leprol. 2013;79(3):389-98. PMID: 23619444 DOI: 10.4103/0378-6323.110749
9. Sehgal VN, Srivastava G. Toxic epidermal necrolysis (TEN) Lyell's syndrome. J Dermatolog Treat. 2005;16(5-6):278-86. PMID: 16428146 DOI: 10.1080/09546630500375684
10. Roujeau JC, Stern RS. Severe adverse cutaneous reactions to drugs. N Engl J Med. 1994;331(19):1272-85. PMID: 7794310 DOI: 10.1056/NEJM199411103311906
11. 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(6):558-9. PMID: 7588837
12. McDermott AJ, Taylor BM, Bernstein KM. Toxic epidermal necrolysis from suspected mycoplasma pneumoniae infection. Mil Med. 2013;178(9):e1048-50. PMID: 24005558 DOI: 10.7205/MILMED-D-13-00139
13. Talebi R, Saki N, Raeisi Shahraki H, Owji SH. An epidemiological study of Stevens-Johnson syndrome and toxic epidermal necrolysis during 2010-2015 at Shahid Faghihi Hospital, Shiraz, Iran. Iran J Med Sci. 2018; 43(4):421-5. PMID: 30046212
14. Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current perspectives on Stevens-Johnson syndrome and toxic epidermal necrolysis. Clin Rev Allergy Immunol. 2018;54(1):147-76. PMID: 29188475 DOI: 10.1007/s12016-017-8654-z
15. Yamane Y, Matsukura S, Watanabe Y, Yamaguchi Y, Nakamura K, Kambara T, et al. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 87 Japanese patients--Treatment and outcome. Allergol Int. 2016;65(1):74-81. PMID: 26666483 DOI: 10.1016/j.alit. 2015.09.001
16. Arantes LB, Reis CS, Novaes AG, Carvalho MR, Gottems LB, Novaes M. Stevens-Johnson syndrome and toxic epidermal necrolysis: epidemiological and clinical outcomes analysis in public hospitals. An Bras Dermatol. 2017;92(5):661-7. PMID: 29166503 DOI: 10.1590/abd1806-4841.20176610
17. Rahmati Roodsari M, Gorgzadeh L, Zali H. Cause, clinical course and complications in patients with Stevens- Johnson syndrome and Toxic Epidermal Necrolysis. Res Med. 2013;36(5):66-71. [Persian]
18. Mokhtari F, Nikyar Z, Naeini BA, Esfahani AA, Rahmani S. Adverse cutaneous drug reactions: eight year assessment in hospitalized patients. J Res Med Sci. 2014;19(8):720-5. PMID: 25422656
19. Tangamornsuksan W, Chaiyakunapruk N, Somkrua R, Lohitnavy M, Tassaneeyakul W. Relationship between the HLA-B*1502 allele and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis. JAMA Dermatol. 2013;149(9):1025-32. PMID: 23884208 DOI: 10.1001/ jamadermatol.2013.4114
20. Zhang Y, Wang J, Zhao LM, Peng W, Shen GQ, Xue L, et al. Strong association between HLA-B* 1502 and carbamazepine-induced Stevens-Johnson syndrome and toxic epidermal necrolysis in mainland Han Chinese patients. Eur J Clin Pharmacol. 2011;67(9):885-7. PMID: 21424386 DOI: 10.1007/s00228-011-1009-4
21. Chen P, Lin JJ, Lu CS, Ong CT, Hsieh PF, Yang CC, et al. Carbamazepine-induced toxic effects and HLA-B* 1502 screening in Taiwan. N Engl J Med. 2011;364(12):1126-33. PMID: 21428768 DOI: 10.1056/NEJMoa1009717
22. Wang L, Mei XL. Retrospective analysis of Stevens-Johnson syndrome and toxic epidermal necrolysis in 88 Chinese patients. Chin Med J. 2017;130(9):1062-8. PMID: 28469101 DOI: 10.4103/0366-6999.204929
23. Halevy S, Ghislain 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(1):25-32. PMID: 17919772 DOI: 10.1016/j.jaad.2007.08.036
24. Hung SI, Chung WH, Liou LB, Chu CC, Lin M, Huang HP, et al. HLA-B* 5801 allele as a genetic marker for severe cutaneous adverse reactions caused by allopurinol. Proc Natl Acad Sci U S A. 2005;102(11):4134-9. PMID: 15743917 DOI: 10.1073/pnas.0409500102
25. Somkrua R, Eickman EE, Saokaew S, Lohitnavy M, Chaiyakunapruk N. Association of HLA-B* 5801 allele and allopurinol-induced Stevens Johnson syndrome and toxic epidermal necrolysis: a systematic review and meta-analysis. BMC Med Genet. 2011;12:118. PMID: 21906289 DOI: 10.1186/1471-2350-12-118
26. Ma L, Du X, Dong Y, Peng L, Han X, Lyu J, et al. First case of Stevens–Johnson syndrome after rabies vaccination. Br J Clin Pharmacol. 2018;84(4):803-5. PMID: 29333656 DOI: 10.1111/bcp.13512
27. Khafaga YM, Jamshed A, Allam AA, A. Mourad W, Al Eisa A, Ezzat A, et al. Stevens-Johnson syndrome in patients on phenytoin and cranial radiotherapy. Acta Oncologica. 1999;38(1):111-6. PMID: 10090698
28. Eralp Y, Aydiner A, Tas F, Saip P, Topuz E. Stevens-Johnson syndrome in a patient receiving anticonvulsant therapy during cranial irradiation. Am J Clin Oncol. 2001;24(4):347-50. PMID: 11474258
29. Oner Dincbas F, Yörük S, Demirkesen C, Uzel O, Koca S. Toxic epidermal necrolysis after cranial radiotherapy and phenytoin treatment. Onkologie. 2004;27(4):389-92. PMID: 15347896 DOI: 10.1159/000079094
30. Murphy JT, Purdue GF, Hunt JL. Toxic epidermal necrolysis. J Burn Care Rehabil. 2002;23(2):87-96. PMID: 9313122
31. McGee T, Munster A. Toxic epidermal necrolysis syndrome: mortality rate reduced with early referral to regional burn center. Plast Reconstr Surg. 1998;102(4):1018-22. PMID: 9734418
32. Ghislain PD, Roujeau JC. Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Dermatol Online J. 2002;8(1):5. PMID: 12165215
33. Tegelberg-Stassen MJ, van Vloten WA, Baart de la Faille H. Management of nonstaphylococcal toxic epidermal necrolysis: follow-up study of 16 case histories. Dermatologica. 1990;180(3):124-9. PMID: 2187719
34. Halebian PH, Corder VJ, Madden MR, Finklestein JL, Shires GT. Improved burn center survival of patients with toxic epidermal necrolysis managed without corticosteroids. Ann Surg. 1986;204(5):503-12. PMID: 3767483
35. Cheriyan S, Patterson R, Greenberger PA, Grammer LC, Latall J. The outcome of Stevens-Johnson syndrome treated with corticosteroids. Allergy Proc. 1995;16(4):151-5. PMID: 8566720
36. Singh G, Chatterjee M, Verma R. Cyclosporine in Stevens Johnson syndrome and toxic epidermal necrolysis and retrospective comparison with systemic corticosteroid. Indian J Dermatol Venereol Leprol. 2013;79(5):686-92. PMID: 23974585 DOI: 10.4103/0378-6323.116738
37. Kirchhof MG, Miliszewski MA, Sikora S, Papp A, Dutz JP. Retrospective review of Stevens-Johnson syndrome/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine. J Am Acad Dermatol. 2014;71(5):941-7. PMID: 25087214 DOI: 10.1016/j. jaad.2014.07.016
38. Zarate-Correa L, Carrillo-Gomez D, Ramirez-Escobar A, Serrano-Reyes C. Toxic epidermal necrolysis successfully treated with infliximab. Case Rep Crit Care. 2017;23(1):61-3. PMID: 23653980
39. Scott‐Lang V, Tidman M, McKay D. Toxic epidermal necrolysis in a child successfully treated with infliximab. Pediatr Dermatol. 2014;31(4):532-4. PMID: 23072342 DOI: 10.1111/pde.12029
40. Wojtkiewicz A, Wysocki M, Fortuna J, Chrupek M, Matczuk M, Koltan A. Beneficial and rapid effect of infliximab on the course of toxic epidermal necrolysis. Acta Derm Venereol. 2008;88(4):420-1. PMID: 18709327 DOI: 10.2340/00015555-0462

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