Experience With Intravenous Immunoglobulins In Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis Overlap And Toxic Epidermal Necrolysis

Objective: is to evaluate the possible beneficial effect of IVIG in the management of SJS/TEN overlap and TEN and their possible relation to the outcome in these cases. Patients Methods: This study was carried out retrospectively. A search was performed in the medical records for patients admitted with the diagnosis of Stevens-Johnson syndrome (SJS), SJS/TEN (toxic epidermal necrolysis) overlap, and TEN to Alnoor Specialist Hospital, the Holy Makkah, Saudi Arabia, during the period from March 2003 to March 2008. The diagnosis relied on the clinical manifestations. Classification of the patients into SJS, SJS/TEN overlap, and TEN relied on the percentage of the body surface area (BSA) involved with epidermal detachment. Age, sex, implicated drug, involved and non-involved sites of the skin and mucous membranes, percentage of BSA involved with tender erythema and/or Nikolsky s sign and skin detachment, and infectious manifestations and complications were reported. Treatment before and after admission in addition to the outcome of treatment were reviewed. Results: Nine patients [2 with SJS/TEN overlap (1 female and 1 male) and 7 with TEN (5 males and 2 females)] were managed during the period from March 2003 to March 2008. The average age of them was 50.5 years. Drugs were implicated in all patients (9/9, 100%). The average BSA that showed epidermal detachment was 57%. Five patients (1 with SJS/TEN overlap and 4 with TEN) have received intravenous fluids, corticosteroids, and antibiotics, but not IVIG before admission to our hospital. IVIG were used in an average dose of 3.76 gm/kg over an average duration of 4.7 days. New blister formation has halted after an average duration of 3.4 days. Complete healing was achieved in 7 patients after an average duration of 8.7 days. The remaining 2 patients died because of sepsis while healing of the lesions was going on. Conclusions: Drug-induced SJS/TEN and TEN are life-threatening conditions that necessitate early therapeutic intervention. We support the use of high dose IVIG without using either corticosteroids or prophylactic antibiotics systemically for treating these conditions.