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Drug-induced liver injury Associated with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Patient Characteristics, Causes and Outcome in 36 Cases.
Hepatology. 2015 Oct 5;
Authors: Devarbhavi H, Raj S, Aradya VH, Rangegowda VT, Veeranna GP, Singh R, Reddy V, Patil M
Abstract
The liver and skin are the organs most commonly involved by serious adverse drug reactions. Rarely a drug reaction can affect both organs concurrently. The association of drug-induced liver injury (DILI) and Stevens-Johnson syndrome (SJS) or toxic epidermal necrosis (TEN) is even rarer and is not well studied. We describe our experience of DILI occurring in association with SJS/TEN including the etiologic agents, clinical and biochemical characteristics and outcome. We identified patients who developed DILI in association with SJS/TEN from a registry of DILI patients from a single center. Causality assessment for DILI and SJS/TEN was carried out with Roussel Uclaf Causality Assessment Method (RUCAM) and Algorithm for Drug Causality for Epidermal Necrolysis (ALDEN) respectively. Among 748 consecutive patients with DILI from 1997-March2015, 36 (4.8%) had associated features of SJS/TEN. The mean age was 32 years (Females 19). Children and patients with HIV constituted 25% (n=9) and 22% (n=8) respectively. Only a small number of "high risk" drugs such as antiepileptic agents, sulfonamides and antiretroviral drugs accounted for the majority of cases. Overall mortality was 36% (n=13) which rose to 45.5% in presence of jaundice. Mortality was less in children 11% (n=1) and HIV patients 12.5% (n=1).
CONCLUSIONS: DILI associated with SJS/TEN is rare and is associated with a high death rate particularly in those with jaundice. However, children and HIV infected individuals have a favorable outcome. A small group of drugs contributed to a disproportionate number of cases. Causality with RUCAM and ALDEN was highly probable or probable in all cases. This article is protected by copyright. All rights reserved.
PMID: 26439084 [PubMed - as supplied by publisher]