Drug-induced Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Ten-year Retrospective Study of 103 Cases.

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening conditions with high mortality, most frequently caused by drugs.

Methods: A retrospective study was reviewed at a tertiary hospital in China during the period of 2013 to 2023. The aim of this study was to evaluate and compare the demographic, laboratory and clinical features, culprit drugs, complications, treatment and outcome of drug-induced SJS/TEN patients.

Results: The study population included 54 SJS patients, 17 SJS-TEN overlap patients, and 32 TEN patients. The average age was 49.0±21.5 years (range: 1-90 years). Females were predominant, with a female to male ratio of 1.34:1. Antibiotics (34.0%), non-steroidal anti-inflammatory drugs (NSAIDs) (16.5%), and anticonvulsants (14.6%) were the most frequently implied drug categories, with carbamazepine, levofloxacin, ibuprofen, aspirin, amoxicillin, metronidazole and lamotrigine being the most common individual causative drugs. In addition to mucosal involvement, liver dysfunction, pneumonia, and heart involvement were the most common complications of SJS/TEN. Almost all patients except one were treated with the systemic corticosteroid treatment, and 47.6% of patients received intravenous immunoglobulin (IVIG) combined with steroid therapy. The mortality rate was 9.7% overall, with the highest mortality in the TEN group, at 15.6%. Moreover, there was no statistical difference between the predicted and actual mortality (12.6% vs. 9.7%) (P=0.507).

Conclusions: In our study, carbamazepine, levofloxacin, ibuprofen, aspirin, amoxicillin, metronidazole and lamotrigine were the most common triggers for SJS/TEN. If combined with high-risk factors such as pneumonia, renal insufficiency, gastro-intestinal disorder, cardiac involvement and sepsis, SJS/TEN patients might have a higher risk of mortality.