The Multiorgan Complications of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review.

Abstract

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening mucocutaneous reactions causing necrosis of external and internal body surfaces, thereby predisposing patients to multiorgan complications. Numerous internal organ systems are impacted by SJS-TEN, encompassing the skin, ocular, ear, nose, and throat (ENT), pulmonary, gastrointestinal (GIT), and genitourinary systems. The acute and long-term organ complications associated with SJS-TEN have not been comprehensively documented. The objective of this review is to systematically delineate multiorgan complications in cases of SJS-TEN. A comprehensive search of the available literature was conducted on electronic databases (PubMed and Scopus) published between 2019 and 2024, reporting SJS-TEN patients with multiorgan complications using predefined search terms and inclusion/exclusion criteria. The terms "Stevens-Johnson syndrome", "toxic epidermal necrolysis", "organ complication", "multiorgan involvement", and "sequelae" were used as keywords. We included 38 articles reporting SJS-TEN patients with multiorgan complications, comprising 15 reviews, 11 original studies, 9 case reports, and 3 case series; data were synthesized descriptively, and no quantitative meta-analysis was performed. Reported percentages therefore reflect the proportion of included studies reporting a given complication, not patient-level prevalence. Among studies providing extractable patient-level data, the mean age of the subject population was 36.72 ± 26.58 years, with female predominance (88.2%). Ocular involvement was the complication most frequently reported across the included studies (65.8% of studies), followed by pulmonary and genitourinary involvement (26.32% of studies each) and skin complications (21.05% of studies). The most frequently reported ocular complications were trichiasis, distichiasis, and symblepharon, each noted in 60% of studies reporting ocular involvement. SJS-TEN represents a severe delayed-type hypersensitivity reaction with a high risk of long-term mucocutaneous disabling effects. Given the heterogeneity of the included study designs, these findings should be interpreted as an indication of how frequently each complication has been reported in the literature rather than as an estimate of true patient-level risk. This systematic review emphasizes the importance of clinician awareness to ensure early detection of multiorgan complications associated with SJS-TEN, thereby ensuring optimal, multidisciplinary patient management.