Stevens-Johnson syndrome and toxic epidermal necrolysis in Thailand.
BACKGROUND
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially life-threatening illnesses that have often been linked to drug exposure.


METHODS
We looked retrospectively for all cases of SJS and TEN that were admitted to Siriraj Hospital between 1981 and 1990 to determine the drug etiology.


RESULTS
Fifty-eight cases of SJS and 20 cases of TEN were identified. Eight patients initially had an SJS-like aspect, which subsequently evolved into TEN. A culpable drug was determined in 60 patients (77%). The mean time from first drug administration to onset of SJS or TEN was 6.8 +/- 6.5 days (range, 1 to 28 days). A longer incubation period was observed with thiacetazone (10.5 +/- 5.6 days), phenytoin (12 +/- 8.5 days), and carbamazepine (11.3 +/- 3.4 days).


CONCLUSIONS
The culprit drugs included the following: antibiotics, 32 cases (penicillin, sulfonamides, tetracycline, erythromycin); anticonvulsants, nine (phenytoin, carbamazepine, barbiturates); antitubercular drugs, eight (thiacetazone); analgesics, four (acetylsalicylic acid, fenbufen); sulfonylurea, two; allopurinol, one; and others, four. The most frequent underlying diseases justifying the ingestion of one or more drugs in our patients were infections (52.7%), followed by pulmonary tuberculosis (10.8%), and by seizures (8.1%). The total mortality rate was 14%; 5% for SJS, and 40% for TEN. Mortality was not affected by the type of drug responsible.
Leenutaphong
V
V
Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Sivayathorn
A
A
Suthipinittharm
P
P
Sunthonpalin
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000008:administration & dosage / Q000009:adverse effects; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D004194:Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010406:Penicillins / Q000008:administration & dosage / Q000009:adverse effects; D012189:Retrospective Studies; D018805:Sepsis / Q000209:etiology; D012874:Skin Diseases, Infectious / Q000209:etiology; D013262:Stevens-Johnson Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects; D013785:Thailand; D013828:Thioacetazone / Q000008:administration & dosage / Q000009:adverse effects; D013997:Time Factors
D000927:Anticonvulsants; D010406:Penicillins; D013449:Sulfonamides; D013828:Thioacetazone