A study on drug induced Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN) and SJS-TEN overlap in a tertiary care hospital of Northeast India

Abstract

Background: Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and SJS-TEN overlap are rare, but potentially life-threatening, reactions to medications. From Northeast India, limited epidemiological data is available on these cutaneous drug reactions. Aims: The purpose of this study was to assess the drug-induced SJS/TEN cases of a tertiary care hospital of Northeast India. Methods: This cross sectional study was conducted in Gauhati Medical College and Hospital of Guwahati city, Northeast India. WHO-UMC probability assessment system and ALDEN were used for causality assessment of reported SJS/TEN cases. Results are presented in percentage; mean (standard deviation), and median (interquartile range difference). Results: Forty five cases of drug induced SJS (42.22%), TEN (55.55%) & SJS-TEN (2.22%) overlap were reported. Out of these, 25 patients were males and 20 patients were females. The mean age of the patients was 29.69 (17.57) year. The median time duration between drug intake and onset of symptoms for SJS/TEN was 25(4) and the median duration of hospital stay by patients was 13(8). The most offending groups of drugs were antimicrobials (35.55%), followed by anticonvulsants (28.89%), antipyretics (17.78%), and nonsteroidal anti-inflammatory drugs (6.67%). In individual drug category, paracetamol (17.77%) and phenytoin (15.55%) were among the commonly reported offending drugs. Altered liver function test was commonly reported complication in SJS/TEN patients. As per ALDEN, drug causality was very probable in 16 cases whereas by WHO-UMC assessment system, 1 case was certain while 29 cases were probable. Limitations: Statistical significance among the variables was not shown and large study sample may be required for interpretation of results to arrive at a definite conclusion. Conclusions: Antimicrobials, anticonvulsants, and antipyretics were commonly reported group of offending drugs to cause SJS/TEN in patients. Paracetamol & phenytoin were commonly reported individual offending drugs.

Aetiopathogenesis of severe cutaneous adverse reactions (SCARs) in children: A 9‐year experience in a tertiary care paediatric hospital setting

“…The total incidence of SCARs in hospitalized patients was 0.32% with median age at reaction of 6.5 years (range 1‐17) and SJS/TEN and AGEP mainly occurring in adolescents, consistently with the existing literature . There was no significant difference in the incidence between male and female children (M/F ratio 1.3:1); however, SJS was slightly prevalent in males (ratio 1.5:1), as well as in DRESS (M/F ratio 1.8:1), as reported elsewhere …”

“…In a recent review, Adler et al summarize three major algorithms to assess drug causality in SCARs: the Naranjo scale, the Algorithm of Drug Causality for Epidermal Necrolysis (ALDEN) for SJS/TEN, the European Registry of Severe Cutaneous Adverse Reactions to Drugs (RegiSCAR) criteria, the Japanese group of Severe Cutaneous Adverse Reactions to Drugs (SCAR‐J) criteria for DRESS, the European Study of Severe Cutaneous Adverse Reactions scoring system for AGEP . In literature, the rate of hospital admissions for SCARs is reported to be from 0.3 up to 3.6/1000 and many epidemiological studies focused on SCARs analysed incidence, demographic characteristics of patients, possible triggers and mortality rate in a hospital setting . In most of them, diagnosis was based on clinical features and history of drug administration, without allergy investigation, except for a few .…”

Phenytoin induced Stevens-Johnson syndrome: a case report

“…In a study, 28.8% of all SJS/TEN cases were due to antiepileptic agents of which, phenytoin was the most common drug. 8 She was prescribed phenytoin, following consumption of which the patient developed SJS. 9 Bhanu et al reported a case of SJS in a 30 year old female who had received phenytoin for seizure disorder.…”

An Evaluation of Pharmacological Management of Pemphigus Vulgaris and its Impact on Quality of Life

“…In our study, patients developed pedal edema, fever, acne, oral candidiasis, urinary tract infection, weight gain, hyperglycemia, infection, pneumonia, diabetes mellitus and hypertension who administered dexamethasone or prednisolone. In a study carried out by Lihite et al, (2016) it was reported that the patient treated with corticosteroid therapy also developed ADRs such as oral candidiasis, pulmonary edema, hyperglycemia, secondary infections, electrolytes imbalance, gastritis, lung abscess, psychosis, and septicaemia. 24 Major disadvantage with rituximab is higher cost as rituximab is too expensive.…”

“…In a study carried out by Lihite et al, (2016) it was reported that the patient treated with corticosteroid therapy also developed ADRs such as oral candidiasis, pulmonary edema, hyperglycemia, secondary infections, electrolytes imbalance, gastritis, lung abscess, psychosis, and septicaemia. 24 Major disadvantage with rituximab is higher cost as rituximab is too expensive.…”