Drug-induced Stevens-Johnson syndrome and toxic epidermal necrolysis: a 10-year retrospective study of 103 cases

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

To evaluate and compare the demographic, laboratory and clinical features, culprit drugs, complications, treatment and outcomes of patients with drug-induced SJS/TEN.

A retrospective study was performed at a tertiary hospital in China during the period 2013-2023.

The study population included 103 patients: 54 with SJS, 17 with SJS/TEN overlap and 32 with TEN. The average age was 49 years (SD 21.5, range 1-90). There were more female than male patients, at a ratio of 1.3 : 1. Antibiotics (34.0%), nonsteroidal anti-inflammatory drugs (16.5%) and anticonvulsants (14.6%) were the most frequently implicated drug categories. Carbamazepine, levofloxacin, ibuprofen, aspirin, amoxicillin, metronidazole and lamotrigine were 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. All patients except one were treated with systemic corticosteroids, and 47.6% of patients received intravenous immunoglobulin combined with steroid therapy. The mortality rate was 9.7% overall, with the highest mortality in those with TEN, at 16%. There was no statistical difference between the predicted and actual mortality (12.6% vs. 9.7%; P = 0.51).

In our study, carbamazepine, levofloxacin, ibuprofen, aspirin, amoxicillin, metronidazole and lamotrigine were the most common triggers for SJS/TEN. Patients with SJS/TEN might have a higher risk of mortality if they have high-risk factors such as pneumonia, renal insufficiency, gastrointestinal disorder, cardiac involvement and sepsis.