Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and SJS-TEN Overlap: Etiologies and Clinical Outcomes in BMA Medical College and Vajira Hospital

Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and SJS-TEN Overlap: Etiologies and Clinical Outcomes in BMA Medical College and Vajira Hospital Wanjarus Roongpisuthipong MD* Theerawut Klangjareonchai MD** Tikumporn Komkris MD* * Division of Dermatology, Department of Medicine, BMA Medical College and Vajira Hospital, Bangkok, Thailand. ** Department of Pharmacology, Faculty of Science, Mahidol University, Bangkok, Thailand. Objectives: To determine etiologies, treatments and outcomes of SJS, TEN and SJS-TEN overlap in BMA Medical College and Vajira Hospital. Study design: Retrospective descriptive study. Subjects: Thirty-five patients with 36 episodes of SJS, TEN and SJS-TEN overlap, who were admitted at our institution between March 2004 and June 2008. Methods: Clinical data including drug used, treatment and clinical outcomes of the studied patients were retrospectively reviewed from medical records. Main outcome measures: Etiologies, treatments, complications and mortality of SJS, TEN and SJS-TEN overlap. Results: There were 26 episodes (72.2%) of SJS, 9 episodes (25.0%) of TEN and 1 episode (2.8%) of SJS-TEN overlap. Mean age of the patients was 42.5 ± 21.0 years (3-85 years). Major etiologies were drugs, identified in 34 cpisodes (94.4%). Antibiotics were the most common culprits (38.9%), followed by allopurinol (22.2%). Penicillin and sulfonamide were the most common drugs in antibiotic group. All patients received standard care such as wound care, fluid and electrolyte replacement. Among these, corticosteroids and intravenous immunoglobulin were given in 7 cases (19.4%) and 1 case (2.8%) respectively. Average length of hospital stay was 14.0 ± 9.6 days. Complications during hospitalization occurred in 19 patients (52.8%). The common complications were septicemia (10 cases, 27.8%), followed by acute renal failure (7 cases, 19.4%). Overall mortality rate was 25.0% (9 cases), the most common cause was sepsis. Conclusion : Culprits of SJS, TEN and SJS-TEN overlap in BMA Medical College and Vajira Hospital were drugs, mainly from antibiotic agents, followed by allopurinol. The mortality rate of this syndrome was 25.0% Vajira Med J 2009 ; 53 : 69 - 75