Aetiology of Febrile Mucocutaneous Syndromes with Special Reference to the Provocative Role of Infections and Drugs

Abstract

The survey covers 266 patients with febrile mucocutaneous syndromes. A brief account of the highly varied clinical picture is given. The syndromes constitute an allergic reaction which in most drug‐provoked cases appeared as a late immunological reaction of serum disease type; for the rest sensitization had probably often taken place. An allergic disposition could be traced in 34% of the cases. Infections and drugs were the causative factor in 235 cases (88.3%). Infections accounted for 25.2%, drugs for 36.1% and both together for 27.1%. An account is given of the provocative bacterial and viral infections and of the role of drugs in cases with and without infection. Among the remaining 31 cases an infection and/or drug may have been the provocative agent in 16 (6%) whereas 15 (5.6%) may have been due to alimentary and other factors.

Child With Stevens-Johnson Syndrome Associated With PCR-Confirmed Adenovirus Infection

“…The first of the 3 cases reported by Ström did not show an increase in the complement fixation titer (1/64). 14 In the second case, the complement fixation titer increased only by 2-fold (1/64-1/128) and phenytoin was given, 16 an agent strongly associated with SJS. 1,5,6 Finally, the third patient had clinical signs of mild SJS and a 16-fold increase of the complement fixation titer for adenovirus (1/4-1/64), 16 a rise in titer that could indeed indicate acute infection.…”

“…Previous reports suggest that adenovirus might be a triggering factor for SJS. 12,[14][15][16] However, in some of these reports, the acute infection could be considered doubtful, 16 while in others more than one possible etiologic factors were present. 12,16 Our report is the first to provide evidence for the association between acute adenovirus infection and SJS in the pediatric population by confirmation of the viremia on blood PCR and exclusion of other etiologic factors.…”

“…Similarly, little information is available in the adult literature. [14][15][16] We report herein the first pediatric case of SJS associated with acute, polymerase chain reaction (PCR)confirmed, adenoviral infection.…”

“…6,8,9 Adenovirus is considered a possible trigger for SJS. 12,[14][15][16] To our knowledge, there are only 4 published pediatric cases suggesting an association between adenovirus and SJS. 12,16 However, the presence of an acute infection is deniable in these reports, while, on some occasions, other possible trigger factors coexisted.…”

“…1,6,9,10 Since 2015, the new term “ Mycoplasma -Induced Rash and Mucositis (MIRM) has been suggested to describe the previously known “ Mycoplasma -induced SJS,” which is now considered as a distinct mucocutaneous eruption entity. 11 Although many authors believe in the existence of virus-induced SJS, 1,9,12-14 only a few viral agents have been proven to be etiologic factors of SJS. 1 Ιn fact, in many cases, no causative agent was identified, and SJS was eventually classified as of unknown cause.…”