Reaction to TMP/SMZ most common cause of Stevens-Johnson Syndrome

Stevens-Johnson syndrome is a rare, serious disorder of the skin and mucous membranes usually due to a reaction to a medication or an infection. Robert G. Micheletti at Departments of Dermatology & Medicine, University of Pennsylvania, Philadelphia, and associates conducted a retrospective study in a large cohort of US patients of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) to investigate its causes, treatment protocols, and mortality rates and found that reaction to TMP/sulfamethoxazole was most common cause of Stevens-Johnson Syndrome. The results were published in the Journal of Investigative Dermatology.

The researchers in a multicenter retrospective study included patients who were seen by inpatient consultative dermatologists at 18 medical centers in the country between January 1, 2000, and June 1, 2015.

The researchers found that medication reaction was the most frequent cause of SJS/TEN (89.7%), with 27.2% of the cases involving trimethoprim/sulfamethoxazole. The patients were treated either in a burn unit (41.0%) or in intensive care (27.2%). Treatment was administered to 70.7% of patients which consisted of corticosteroids (42.5%), intravenous immune globulin (35.3%), or both (20.3%). About one-third of patients were given only supportive care (29.3%).

Seventy-eight in-hospital deaths were expected (21%) based on Day 1 SCORTEN, a severity-of-illness score for TEN, but observed mortality was significantly lower at 14.7%. The SMR was lowest among patients who received both corticosteroids and intravenous immune globulin.

"Mortality, while substantial, was significantly lower than predicted," the authors concluded. "While the precise role of pharmacotherapy remains unclear, co-administration of corticosteroids and [intravenous immune globulin), among other therapies, may warrant further study."

This large cohort provides comprhensive information regarding US patients with SJS/TEN.