Five years of a single burn center experience with toxic epidermal necrolysis: retrospective study of causative drugs and the clinical outcome

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but potentially life-threatening reactions to medications. Both conditions have significant morbidity and mortality. This study aimed to document the epidemiological features, aetiologies, treatment and clinical outcomes of such patients.Method: In this retrospective cross-sectional study the records of all patients with TEN treated for۵ years in central Hospital, Mashhad, Iran were reviewed. Results: Thirty-four patients were studied with a mean age of ۲۶.۵ years. Mean age in the mortality and survivors groups was ۳۳.۶ and ۲۵.۳ years, respectively. Drugs accounted for all ۳۴ cases were including Anti-convulsants (۵۲.۹%) other the most common implicated drug followed by antibiotics (۲۶.۵%), allopurinol (۵.۹%) and multiple drugs (anticonvulsants plus antibiotics) (۱۴.۷%). Antibiotics had the shortest interval between ingestion time and onset of symptoms. The mean ICU length of stay was ۱۲.۷ days, with a range of ۱ to ۳۰ days. The mean of SCORTEN was ۲.۳; it was ۳.۳ and ۲.۱ in the mortality and survivors group, respectively (P=۰.۰۰۱).All ۳۴ TEN cases were given intravenous immunoglobulins (IVIG). Six patients with TEN died (۱۷.۶%). The highest mortality was found in the allopurinol group with ۵۰%, whereas anticonvulsants and antibiotics had a mortality rate of ۱۶.۶% and ۱۵.۳%, respectively.Conclusion: Anti-convulsants especially Lamotrigine were the most frequently implicated drug, followed by antibiotics and allopurinol. IVIG was shown beneficial effects in TEN syndrome.

Keywords:

Toxic epidermal necrolysis (TEN) , drug , Anticonvulsants , Mortality