Effect of Infectious Diseases on the Pathogenesis of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis

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  • Okamoto-Uchida Yoshimi
    Division of Medicinal Safety Science, National Institute of Health Sciences
  • Nakamura Ryosuke
    Division of Medicinal Safety Science, National Institute of Health Sciences
  • Sai Kimie
    Division of Medicinal Safety Science, National Institute of Health Sciences
  • Imatoh Takuya
    Division of Medicinal Safety Science, National Institute of Health Sciences
  • Matsunaga Kayoko
    Department of Integrative Medical Science for Allergic Disease, School of Medicine, Fujita Health University
  • Aihara Michiko
    Department of Environmental Immuno-Dermatology, Graduate School of Medicine, Yokohama City University
  • Saito Yoshiro
    Division of Medicinal Safety Science, National Institute of Health Sciences

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Abstract

<p>Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reactions. Recent studies have revealed that the prevalence of SJS/TEN is associated with genetic backgrounds, such as polymorphisms in human leukocyte antigens (HLAs). However, non-genetic factors contributing to the etiology of SJS/TEN are largely unknown. This study aimed to assess the involvement of concurrent infection on the pathological states of SJS/TEN, examining the severity of cutaneous symptoms and ocular involvement as well as the time to onset in drug-induced SJS/TEN patients. We recruited 257 Japanese SJS/TEN patients from June 2006 to September 2013 through a nationwide case collection network and participating hospitals and reviewed the clinical information including patient backgrounds, primary disease and medication status. Association between infection and pathological states of SJS/TEN was assessed using univariate and multivariate analyses. The concurrent infectious group of SJS/TEN patients showed a significantly higher rate of exhibiting severer dermatological and ophthalmological phenotypes and an earlier onset of SJS/TEN than the non-infectious group. Our results suggest that the infection could be a risk factor to cause severer symptoms and earlier onset of SJS/TEN.</p>

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