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Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic Wetter DA; Camilleri MJMayo Clin Proc 2010[Feb]; 85 (2): 131-8OBJECTIVE: To examine clinical, etiologic, and histologic features of Stevens-Johnson syndrome and to identify possible correlates of clinical disease severity related to etiologic and histopathologic findings. PATIENTS AND METHODS: This is a retrospective review of patients seen at Mayo Clinic between January 1, 2000, and December 31, 2007. RESULTS: Of 27 patients (mean age, 28.1 years), 22 (81%) had involvement of 2 or more mucous membranes, and 19 (70%) had ocular involvement. Medications, most commonly antibiotics and anticonvulsants, were causative in 20 patients. Mycoplasma pneumoniae infection caused 6 of the 27 cases. Corticosteroids were the most common systemic therapy. No patients with mycoplasma-induced Stevens-Johnson syndrome had internal organ involvement or required treatment in the intensive care unit, in contrast to 4 patients each in the drug-induced group. Three patients had chronic ocular sequelae, and 1 died of complications. Biopsy specimens from 13 patients (48%) showed epidermal necrosis (8 patients), basal vacuolar change (10 patients), and subepidermal bullae (10 patients). Biopsy specimens from 11 patients displayed moderate or dense dermal infiltrate. Histologic features in drug-induced cases included individual necrotic keratinocytes, dense dermal infiltrate, red blood cell extravasation, pigment incontinence, parakeratosis, and substantial eosinophils or neutrophils. CONCLUSION: Our clinical and etiologic findings corroborate those in previous reports. M pneumoniae-induced Stevens-Johnson syndrome manifested less severely than its drug-induced counterpart. The limited number of biopsies precludes unequivocal demonstration of histopathologic differences between drug-induced and M pneumoniae-induced Stevens-Johnson syndrome.|*Severity of Illness Index[MESH]|Adolescent[MESH]|Adult[MESH]|Age Distribution[MESH]|Aged[MESH]|Anti-Bacterial Agents/adverse effects[MESH]|Anti-Inflammatory Agents/therapeutic use[MESH]|Anticonvulsants/adverse effects[MESH]|Biopsy[MESH]|Causality[MESH]|Child[MESH]|Child, Preschool[MESH]|Female[MESH]|Humans[MESH]|Infant[MESH]|Male[MESH]|Middle Aged[MESH]|Minnesota/epidemiology[MESH]|Outpatient Clinics, Hospital[MESH]|Pneumonia, Mycoplasma/complications[MESH]|Prognosis[MESH]|Retrospective Studies[MESH]|Stevens-Johnson Syndrome/drug therapy/epidemiology/*etiology/*pathology[MESH] |
