Abstract
Purpose :
Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis Syndrome (TENS) are potentially lethal adverse drug reactions characterized by acute inflammation and necrosis of the skin, mucous membranes, and ocular surface. SJS/TENS is defined on a spectrum based on the percent of total body surface area (%TBSA) with epidermal detachment: SJS (<10% TBSA), Overlap Syndrome (10-30%), and TENS (>30%).
The purpose of this study is to report a 15-year retrospective trend analysis of the SJS spectrum diagnoses and associated culprit drugs in patients admitted to the Loyola Burn Intensive Care Unit (BICU).
Methods :
The electronic medical records of patients with a confirmed diagnosis of SJS/TENS admitted to the Loyola BICU from 2002 to 2017 were reviewed. Clinical data and the algorithm of drug causality for epidermal necrolysis (ALDEN) were used to identify the single most probable culprit drug. The following data were reviewed: admission date, %TBSA with detachment, biopsy confirmation, and possible inciting agents (Table1). Chi-square tests were used to assess statistical significance for group comparisons.
Results :
Over 15 years, 147 patients had a biopsy-confirmed diagnosis of SJS/TENS, of which 67% (n =98) had a culprit drug identified. The most common classification was TENS (n=73), followed by SJS (n=46) and Overlap Syndrome (n=27). Anticonvulsants (n=24), fluoroquinolones (n=14), allopurinol (n=11), sulfa drugs (n=9), and NSAIDs (n=9) were the most common inciting agents. From 2006-2017, the proportion of patients presenting with SJS increased as compared to TENS and Overlap syndrome (10% in 2002-2009 vs. 42% in 2010-2017, p<0.01). Sulfa drug reactions were more prevalent in recent years (0% in 2002-2009 vs. 18% in 2010-2017, p=0.065) and fluoroquinolone-induced reactions in earlier years (21% in 2002-2009 vs. 6% in 2010-2017, p=0.068) (Graph 1).
Conclusions :
We present one of the largest single-center case series in the US, providing trend data similar to the results of two large series: the EuroSCAR (1997-2001) and RegiSCAR (2003-2012) studies which demonstrates that ALDEN provides a validated method for culprit drug determination. Culprit drug trends must be continually monitored to advise providers on which agents present the greatest risk to patients
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.