Korean J Asthma Allergy Clin Immunol.  2006 Dec;26(4):277-281.

Comparison of Clinical Characteristics according to Infection in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Abstract

BACKGROUND AND OBJECTIVE
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening adverse drug reactions. Early the diagnosis and withdrawal of any causative drugs is essential. In most cases, SJS/TEN presents as febrile illness and differencial diagnosis of accompanied infections is mandatory. However, data on clinical characteristics of SJS/TEN according to presence of infections are rarely reported. This study was conducted to compare the clinical characteristics according to infections and to find useful parameters to suggest infection before culture reports in SJS/TEN. METHOD: May 2004 through May 2006, all patients with SJS/TEN were enrolled and divided into two groups: without infections as group A and with infections as group B. The medical records were analyzed in terms of etiologies, vital signs and laboratory data. RESULT: A total of 17 patients with SJS (n=15) and TEN (n=2) were enrolled. The major causative drugs were antibiotics and anticonvulsants. Sixteen of 17 patients had fever 59% of whom over 39oC. Eight of 17 patients had combined infections (catheter related infection, mucocutaneous infection, pneumonia, and cholangitis). Twelve of 17 patients had leukocytosis (11,150~33,930/mm3). All patients had elevated C-reactive protein levels (2.14~29.94 mg/dL), 11 of whom had peak C-reactive protein levels more than 10 mg/dL. However, there were no differences in peak body temperature, white blood cell count, ESR, and CRP levels between groups A (n=9) and B (n=8) (P=0.413, P=0.336, P=0.791 and P=0.847, respectively). Two patients died of sepsis in group B.
CONCLUSION
High fever with leukocytosis may be common in the abscence of accompanying infections in SJS/TEN. There appear to be no significant differences in clinical and laboratory data according to infections in SJS/TEN.

MeSH Terms

Anti-Bacterial Agents
Anticonvulsants
Body Temperature
C-Reactive Protein
Diagnosis
Drug-Related Side Effects and Adverse Reactions
Fever
Humans
Leukocyte Count
Leukocytosis
Medical Records
Pneumonia
Sepsis
Stevens-Johnson Syndrome*
Vital Signs
Anti-Bacterial Agents
Anticonvulsants
C-Reactive Protein