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{{Stevens-Johnson syndrome}}
{{Stevens-Johnson syndrome}}
{{CMG}}
{{CMG}}; {{AE}} {{AHS}}
 
== 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==
==Causes==
* SJS can be caused by infections, usually following viral infections such as:
There are different triggers for Stevens-Johnson Syndrome Include drug-induced, infections, some systemic and [[Autoimmune]] disease among others.
** [[Herpes simplex virus]]
 
** [[Influenza]]
=== Drug Induced SJS: ===
** [[Mumps]]
One of the main triggers to cause SJS is the drug induced reaction
** [[Cat-scratch fever]]
* Usually happens in first 2 months of treatment with drugs (often within 4-28 days)
** [[Histoplasmosis]]
* Typically occur after the first prolonged exposure to drug
** [[Epstein-Barr virus]]
* 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<ref name="pmid19153164">{{cite journal| author=Levi N, Bastuji-Garin S, Mockenhaupt M, Roujeau JC, Flahault A, Kelly JP et al.| title=Medications as risk factors of Stevens-Johnson syndrome and toxic epidermal necrolysis in children: a pooled analysis. | journal=Pediatrics | year= 2009 | volume= 123 | issue= 2 | pages= e297-304 | pmid=19153164 | doi=10.1542/peds.2008-1923 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19153164  }}</ref>:
** Anti-Infective Sulfonamides
** Allupurinol<ref name="pmid17919772">{{cite journal| author=Halevy S, Ghislain PD, Mockenhaupt M, Fagot JP, Bouwes Bavinck JN, Sidoroff A et al.| title=Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel. | journal=J Am Acad Dermatol | year= 2008 | volume= 58 | issue= 1 | pages= 25-32 | pmid=17919772 | doi=10.1016/j.jaad.2007.08.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17919772  }}</ref>
** Anti-Epileptics include
*** [[Phenobarbital (patient information)|Phenobarbital]]
*** [[Carbamazepine]],
*** [[Lamotrigine (patient information)|Lamotrigine]]
*** [[Barbiturates]]
** Antibiotics include
*** [[Pencilllin]]
*** Sufa drugs
*** [[Ciprofloxacin]] has also been reported to be associated with SJS<ref name="pmid14576649">{{cite journal| author=Hällgren J, Tengvall-Linder M, Persson M, Wahlgren CF| title=Stevens-Johnson syndrome associated with ciprofloxacin: a review of adverse cutaneous events reported in Sweden as associated with this drug. | journal=J Am Acad Dermatol | year= 2003 | volume= 49 | issue= 5 Suppl | pages= S267-9 | pmid=14576649 | doi=10.1016/S0190 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=14576649  }}</ref>
** Other Less commonly associated drugs may include
*** [[Acetaminophen]]
*** [[Albendazole]]
*** [[Amifostine]]
***[[Amoxicillin]]
***[[Boceprevir]]
***[[clofarabine]]
***[[Cefadroxil]]
***[[Cefotaxime sodium]]
***[[Certolizumab pegol]]
***[[Ceftazidime]]
***[[Clobazam]]
***[[Etravirine]]
***[[Levobunolol hydrochloride]]
*** [[Diclofenac]]
***[[diclofenac (patch)]]
*** [[Fluconazole]]<ref name="NZ">[http://www.medsafe.govt.nz/profs/Datasheet/d/DiflucanOnecap.htm Medsafe Data Sheet] March 8, 2005. Accessed April 26, 2007.</ref>
***[[Indinavir]]
*** [[Isotretinoin]]
*** [[Lincomycin Hydrochloride]]
*** [[Valdecoxib]]
*** [[Penicillin]]
*** [[Interferon gamma]]
*** [[Barbiturate]]s
*** [[Saquinavir mesylate]]
*** [[Sulfonamide (medicine)|Sulfa]]s
*** [[Phenytoin]]
*** [[Piperacillin]]
*** [[Piperacillin/tazobactam]]
*** [[Modafinil]]
***[[Oxaprozin]]
*** [[Lamotrigine]]
*** [[Nevirapine]]
*** [[Ibuprofen]],<ref>{{cite journal |author=Raksha MP, Marfatia YS |title=Clinical study of cutaneous drug eruptions in 200 patients |journal=Indian J Dermatol Venereol Leprol |volume=74 |issue=1 |pages=80 |year=2008 |pmid=18193504}}</ref> ([[ethosuximide]], [[Carbamazepine]])<ref>{{cite journal |author=Fagot J, Mockenhaupt M, Bouwes-Bavinck J, Naldi L, Viboud C, Roujeau J |title=Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis |journal=AIDS |volume=15 |issue=14 |pages=1843-8 |year=2001 |pmid=11579247 | doi = 10.1097/00002030-200109280-00014 }}</ref><ref>{{cite journal |author=Devi K, George S, Criton S, Suja V, Sridevi P |title=Carbamazepine--the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: a study of 7 years |journal=Indian J Dermatol Venereol Leprol |volume=71 |issue=5 |pages=325-8 |year=2005 |pmid=16394456 |url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2005;volume=71;issue=5;spage=325;epage=328;aulast=Devi}}</ref>
*** [[Infliximab]], [[Imatinib]]
*** [[Rabeprazole]]
*** [[Raltegravir]]
*** [[Ritonavir]]
 
=== Infection Induced SJS ===
SJS can be caused by infections, usually following viral infections:
* [[Herpes simplex virus]]
* [[Influenza]]
* [[Human Immunodeficiency Virus (HIV)|HIV]]
* [[Mumps]]
* [[Hepatitis A]]
* [[Cat-scratch fever]]
* [[Histoplasmosis]]
* [[Epstein-Barr virus]]
Some bacterial infections may be associated with SJS, including following<ref>{{cite web |url=http://dx.doi.org/10.1590/1806-9282.62.05.468 |title=Stevens-Johnson syndrome and toxic epidermal necrolysis: a review |format= |work= |accessdate=}}</ref>:
* [[Group A- Beta Hemolytic streptococci]]
* [[Mycoplasma Pneumoniae]]<ref name="pmid20118388">{{cite journal| author=Wetter DA, Camilleri MJ| title=Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic. | journal=Mayo Clin Proc | year= 2010 | volume= 85 | issue= 2 | pages= 131-8 | pmid=20118388 | doi=10.4065/mcp.2009.0379 | pmc=2813820 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20118388  }} </ref>
* [[Diphtheria|Diptheria]]
* [[Brucellosis]]
* [[Typhoid fever]]
* [[Mycobacterium|Mycobacteria]]


* Allergic reactions to drugs
=== Other Causes ===
** [[Acetaminophen]]
** [[Albendazole]]
**[[Amoxicillin]]
** [[Diclofenac]]
** [[Fluconazole]]<ref name="NZ">[http://www.medsafe.govt.nz/profs/Datasheet/d/DiflucanOnecap.htm Medsafe Data Sheet] March 8, 2005. Accessed April 26, 2007.</ref>
** [[Isotretinoin]]
** [[Valdecoxib]]
** [[Penicillin]]
** [[Barbiturate]]s
** [[Sulfonamide (medicine)|Sulfa]]s
** [[Phenytoin]]
** [[Modafinil]]
** [[Lamotrigine]]
** [[Nevirapine]]
** [[Ibuprofen]],<ref>{{cite journal |author=Raksha MP, Marfatia YS |title=Clinical study of cutaneous drug eruptions in 200 patients |journal=Indian J Dermatol Venereol Leprol |volume=74 |issue=1 |pages=80 |year=2008 |pmid=18193504}}</ref> ([[ethosuximide]], [[Carbamazepine]])<ref>{{cite journal |author=Fagot J, Mockenhaupt M, Bouwes-Bavinck J, Naldi L, Viboud C, Roujeau J |title=Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis |journal=AIDS |volume=15 |issue=14 |pages=1843-8 |year=2001 |pmid=11579247 | doi = 10.1097/00002030-200109280-00014 }}</ref><ref>{{cite journal |author=Devi K, George S, Criton S, Suja V, Sridevi P |title=Carbamazepine--the commonest cause of toxic epidermal necrolysis and Stevens-Johnson syndrome: a study of 7 years |journal=Indian J Dermatol Venereol Leprol |volume=71 |issue=5 |pages=325-8 |year=2005 |pmid=16394456 |url=http://www.ijdvl.com/article.asp?issn=0378-6323;year=2005;volume=71;issue=5;spage=325;epage=328;aulast=Devi}}</ref>
** [[Infliximab]], [[Imatinib]]
** [[Raltegravir]]
* Malignancy ([[carcinoma]]s and [[lymphoma]]s)
* Malignancy ([[carcinoma]]s and [[lymphoma]]s)
* [[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.<ref name="eMedicine">Stevens-Johnson Syndrome-{{eMedicine|emerg|555}}</ref>
* [[Idiopathic]] factors (up to 50% of the time).  SJS has also been consistently reported as an uncommon side effect of herbal supplements containing [[ginseng]].
* Although Stevens Johnson Syndrome may be caused by viral infections or malignancies, severe allergic reactions to medication is the leading cause. Medications that have traditionally been known to lead to Stevens Johnson Syndrome, [[Erythema multiforme]], and [[Lyell's Syndrome]] ([[Toxic Epidermal Necrolysis]]) include;
* SJS may also be caused by [[cocaine]] usage.<ref name="eMedicine">Stevens-Johnson Syndrome-{{eMedicine|emerg|555}}</ref>
** [[Sulfonamide]]s (antibiotics)
** [[Penicillin]]'s (antibiotics)
** [[Barbiturate]]s (sedatives)
** [[Phenytoin]] - Dilantin (anticonvulsant)
*Drug side effects:
*Drug side effects:
** [[Atovaquone and proguanil hydrochloride]]
**[[Cefaclor]]
**[[Ceftibuten]]
**[[Cefotetan disodium]]
**[[Cytomegalovirus immune globulin]]
**[[Dactinomycin]]
**[[Doripenem]]
**[[Ethosuximide]]
**[[Felbamate]]
**[[Imipenem-Cilastatin]]
** [[Ibritumomab tiuxetan]]
**[[Lacosamide]]
**[[Meropenem]]
**[[Meropenem]]
**[[Muromonab-CD3]]
**[[Sorafenib]]
**[[Sorafenib]]
**[[Spironolactone]]
**[[Spironolactone]]
**[[Rifampin]]
**[[Trovafloxacin mesylate]]
**[[Trospium]]
**[[vandetanib]]


==References==
==References==

Latest revision as of 15:36, 15 September 2018

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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

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

References

  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.
  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.
  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.
  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".
  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.
  10. ↑ Stevens-Johnson Syndrome-emerg/555 at eMedicine


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