Stevens-Johnson syndrome causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Anila Hussain, MD [2]

Overview

Stevens-Johnson Syndrome is caused by drug reactions in the majority of the cases although it is also seen in certain viral and bacterial infections, and certain malignancies. Most commonly implicated drugs include sulfa drugs, Allopurinol, Anti-epileptics (phenobarbital, carbamazepine, lamotrigine), antibiotics (for example Penicillin), and NSAIDs. Infections that are associated with SJS may include HIV, HSV, Mumps, Mycoplasma, Mycobacteria, Hepatitis and streptococcal Infection.

Causes

There are different triggers for Stevens-Johnson Syndrome Include drug-induced, infections, some systemic and Autoimmune disease among others.

Drug Induced SJS:

One of the main triggers to cause SJS is the drug induced reaction

Usually happens in first 2 months of treatment with drugs (often within 4-28 days)
Typically occur after the first prolonged exposure to drug
Unlikely to be caused by drugs that are being taken for a long time by the patient
The most commons drugs that can cause SJS include^[1]:
- Anti-Infective Sulfonamides
- Allupurinol^[2]
- Anti-Epileptics include
- Antibiotics include
  - Pencilllin
  - Sufa drugs
  - Ciprofloxacin has also been reported to be associated with SJS^[3]
- Other Less commonly associated drugs may include

Infection Induced SJS

SJS can be caused by infections, usually following viral infections:

Some bacterial infections may be associated with SJS, including following^[8]:

Other Causes

Malignancy (carcinomas and lymphomas)
Idiopathic factors (up to 50% of the time). SJS has also been consistently reported as an uncommon side effect of herbal supplements containing ginseng.
SJS may also be caused by cocaine usage.^[10]
Drug side effects:

References

↑ Levi N, Bastuji-Garin S, Mockenhaupt M, Roujeau JC, Flahault A, Kelly JP; et al. (2009). “Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis”. Pediatrics. 123 (2): e297–304. doi:10.1542/peds.2008-1923. PMID 19153164.
↑ Halevy S, Ghislain PD, Mockenhaupt M, Fagot JP, Bouwes Bavinck JN, Sidoroff A; et al. (2008). “Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel”. J Am Acad Dermatol. 58 (1): 25–32. doi:10.1016/j.jaad.2007.08.036. PMID 17919772.
↑ Hällgren J, Tengvall-Linder M, Persson M, Wahlgren CF (2003). “Stevens-Johnson syndrome associated with ciprofloxacin: a review of adverse cutaneous events reported in Sweden as associated with this drug”. J Am Acad Dermatol. 49 (5 Suppl): S267–9. doi:10.1016/S0190. PMID 14576649.
↑ Medsafe Data Sheet March 8, 2005. Accessed April 26, 2007.
↑ Raksha MP, Marfatia YS (2008). “Clinical study of cutaneous drug eruptions in 200 patients”. Indian J Dermatol Venereol Leprol. 74 (1): 80. PMID 18193504.
↑ Fagot J, Mockenhaupt M, Bouwes-Bavinck J, Naldi L, Viboud C, Roujeau J (2001). “Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis”. AIDS. 15 (14): 1843–8. doi:10.1097/00002030-200109280-00014. PMID 11579247.
↑ Devi K, George S, Criton S, Suja V, Sridevi P (2005). “Carbamazepine–the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: a study of 7 years”. Indian J Dermatol Venereol Leprol. 71 (5): 325–8. PMID 16394456.
↑ “Stevens-Johnson syndrome and toxic epidermal necrolysis: a review”.
↑ Wetter DA, Camilleri MJ (2010). “Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic”. Mayo Clin Proc. 85 (2): 131–8. doi:10.4065/mcp.2009.0379. PMC 2813820. PMID 20118388.
↑ Stevens-Johnson Syndrome-emerg/555 at eMedicine

Template:WikiDoc Sources

[pmid19153164-1] Levi N, Bastuji-Garin S, Mockenhaupt M, Roujeau JC, Flahault A, Kelly JP; et al. (2009). “Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis”. Pediatrics. 123 (2): e297–304. doi:10.1542/peds.2008-1923. PMID 19153164.

[pmid17919772-2] Halevy S, Ghislain PD, Mockenhaupt M, Fagot JP, Bouwes Bavinck JN, Sidoroff A; et al. (2008). “Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel”. J Am Acad Dermatol. 58 (1): 25–32. doi:10.1016/j.jaad.2007.08.036. PMID 17919772.

[pmid14576649-3] Hällgren J, Tengvall-Linder M, Persson M, Wahlgren CF (2003). “Stevens-Johnson syndrome associated with ciprofloxacin: a review of adverse cutaneous events reported in Sweden as associated with this drug”. J Am Acad Dermatol. 49 (5 Suppl): S267–9. doi:10.1016/S0190. PMID 14576649.

[NZ-4] Medsafe Data Sheet March 8, 2005. Accessed April 26, 2007.

[5] Raksha MP, Marfatia YS (2008). “Clinical study of cutaneous drug eruptions in 200 patients”. Indian J Dermatol Venereol Leprol. 74 (1): 80. PMID 18193504.

[6] Fagot J, Mockenhaupt M, Bouwes-Bavinck J, Naldi L, Viboud C, Roujeau J (2001). “Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis”. AIDS. 15 (14): 1843–8. doi:10.1097/00002030-200109280-00014. PMID 11579247.

[7] Devi K, George S, Criton S, Suja V, Sridevi P (2005). “Carbamazepine–the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: a study of 7 years”. Indian J Dermatol Venereol Leprol. 71 (5): 325–8. PMID 16394456.

[8] “Stevens-Johnson syndrome and toxic epidermal necrolysis: a review”.

[pmid20118388-9] Wetter DA, Camilleri MJ (2010). “Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic”. Mayo Clin Proc. 85 (2): 131–8. doi:10.4065/mcp.2009.0379. PMC 2813820. PMID 20118388.

[eMedicine-10] Stevens-Johnson Syndrome-emerg/555 at eMedicine

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