title: Stevens-Johnson syndrome and toxic epidermal necrolysis in patients with malignancies.
abstract: BACKGROUND
  Malignancy is known to be associated with an increased mortality rate in patients with Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, risk factors contributing to the poor prognosis of patients with SJS/TEN with malignancies remain undefined.
  
  
  OBJECTIVE
  To explore the potential involvement of malignancy and its related factors contributing to the poor outcome of SJS/TEN, in a retrospective study.
  
  
  METHODS
  In total 517 patients with SJS/TEN were enrolled. Forty-seven who sustained various types of malignancies were analysed for numerous malignancy-related factors, including cancer types, clinical stages and chemotherapies given or not before the onset of SJS/TEN.
  
  
  RESULTS
  We found that the mortality rate of patients with SJS/TEN with malignancies was higher than that of patients without malignancies (32%, 15/47 vs. 8·5%, 40/470, respectively) (P < 0·001). The use of phenytoin was significantly higher in the malignancy group. The presence of hepatocellular carcinoma (80%, four of five; P < 0·001; odds ratio 43) and colorectal cancer (67%, two of three; P = 0·022; odds ratio 21·5) significantly increased the death rate of patients with SJS/TEN, whereas lung cancer and urothelial carcinoma did not. Patients who had received ongoing or recent chemotherapy showed higher mortality than those without chemotherapy (P = 0·022; odds ratio 4·95). Furthermore, among the 47 patients with SJS/TEN with malignancies, lower serum albumin, haemoglobin and platelet count were detected in the deceased patients than in the surviving patients before the onset of SJS/TEN.
  
  
  CONCLUSIONS
  Our results suggest that several factors related to malignancies, such as specific cancer types, chemotherapy and malnutrition, may contribute to poor prognosis in patients with malignancies developing SJS/TEN.
authors.affiliation: Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
authors.forename: J
authors.initials: J
authors.lastname: Wu
authors.affiliation: Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
authors.forename: Y Y
authors.initials: YY
authors.lastname: Lee
authors.affiliation: Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
authors.forename: S C
authors.initials: SC
authors.lastname: Su
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.|Department of Infectious Disease, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.
authors.forename: T S
authors.initials: TS
authors.lastname: Wu
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.|Department of Thoracic Medicine, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.
authors.forename: K C
authors.initials: KC
authors.lastname: Kao
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.|Department of Thoracic Medicine, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.
authors.forename: C C
authors.initials: CC
authors.lastname: Huang
authors.affiliation: College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.|Department of Hematology-Oncology, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.
authors.forename: W C
authors.initials: WC
authors.lastname: Chang
authors.affiliation: Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
authors.forename: C H
authors.initials: CH
authors.lastname: Yang
authors.affiliation: Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital, Keelung, Taipei and Linkou, 33305, Taiwan.|College of Medicine, Chang Gung University, Taoyuan, 33302, Taiwan.
authors.forename: W H
authors.initials: WH
authors.lastname: Chung
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D018805:Sepsis / Q000401:mortality; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000401:mortality*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D000927:Anticonvulsants; D000970:Antineoplastic Agents