[Analysis of treatments and deceased cases of severe adverse drug reactions--analysis of 46 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis].
BACKGROUND
Systemic administration of corticosteroid, plasmapheresis and high-dose immunoglobulin therapy (IVIG) are the main treatment of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).


OBJECTIVE
To evaluate the effects of the treatments of SJS and TEN.


METHODS
Twenty-seven cases of SJS and 19 cases of TEN treated in our hospitals from 2000 to 2007 were analyzed.


RESULTS
Corticosteroid was administered systemically in all cases except one case of TEN which developed methicillin resistant staphylococcus aureus (MRSA) pneumoniae before the onset of the eruption. Methylprednisolone (mPSL) pulse therapy (1000 mg/day) or mini pulse therapy (less than 600 mg/day of mPSL) was selected by 8 cases of SJS and 9 cases of TEN. Combination of plasmapheresis or IVIG with corticosteroid therapy was performed in 3 cases of SJS and 8 cases of TEN. The mortality rate of patient with SJS was 3.7% (1 case), and with TEN was 21.1% (4 cases). The deceased case of SJS had been treated with corticosteroid alone and died for acute respiratory disorder after 24 days from the onset of the eruption. Four deceased cases of TEN were treated with corticosteroids with or without IVIG, and 2 of them merged sepsis.


CONCLUSIONS
Although corticosteroids may enhance the risk of sepsis, prompt treatment with systemic corticosteroids seems to reduces morbidity and improves outcome of SJS and TEN patients.
Yamane
Yumiko
Y
Department of Environmental Immuno-Dermatology, Yokohama City University Graduate School of Medicine, Japan. yumiko@dream.design.co.jp
Aihara
Michiko
M
Tatewaki
Satoko
S
Matsukura
Setsuko
S
Kanbara
Takeshi
T
Yamakawa
Yuko
Y
Ikezawa
Zenro
Z
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D010951:Plasma Exchange; D011379:Prognosis; D020551:Pulse Therapy, Drug; D013262:Stevens-Johnson Syndrome / Q000628:therapy*
D005938:Glucocorticoids; D007136:Immunoglobulins; D008775:Methylprednisolone