Stevens-Johnson syndrome laboratory findings: Difference between revisions
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==Laboratory Findings== | ==Laboratory Findings== | ||
Skin Biopsy is the only study that can make the definitive diagnosis of SJS. Other | Skin Biopsy is the only study that can make the definitive diagnosis of SJS. Other lab tests are done to detect superimposed bacterial infection or in cases of severe or extensive skin involvement that is more commonly seen in TEN as compared to SJS. | ||
The first | The first step after suspicion of SJS is identifying and discontinuing the offending agent. | ||
Following tests are done<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><ref name="pmid27738400">{{cite journal| author=Çekiç Ş, Canıtez Y, Sapan N| title=Evaluation of the patients diagnosed with Stevens Johnson syndrome and toxic epidermal necrolysis: a single center experience. | journal=Turk Pediatri Ars | year= 2016 | volume= 51 | issue= 3 | pages= 152-158 | pmid=27738400 | doi=10.5152/TurkPediatriArs.2016.3836 | pmc=5047364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27738400 }}</ref>: | Following tests are done<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><ref name="pmid27738400">{{cite journal| author=Çekiç Ş, Canıtez Y, Sapan N| title=Evaluation of the patients diagnosed with Stevens Johnson syndrome and toxic epidermal necrolysis: a single center experience. | journal=Turk Pediatri Ars | year= 2016 | volume= 51 | issue= 3 | pages= 152-158 | pmid=27738400 | doi=10.5152/TurkPediatriArs.2016.3836 | pmc=5047364 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27738400 }}</ref>: | ||
* Skin Biopsy (Urgent Frozen section): Lesional Biopsy and Perilesional Biopsy | * [[Skin Biopsy]] (Urgent Frozen section): Lesional Biopsy and Perilesional Biopsy | ||
* Direct | ** To confirm the diagnosis of Stevens-Johnson Syndrome and rule out other autoimmune skin conditions (for example [[Pemphigus Vulgaris]], [[Bullous pemphigoid]], GVHD, SSSS, [[Linear IgA bullous dermatosis]]) | ||
* Complete Blood Count: Abnormal blood counts can be seen in case of superimposed bacterial infections | ** May show apoptosis and necrosis of [[Keratinocyte|keratinocytes]] along with [[Lymphocyte|lymphocytic]] infiltration of peri-vascular regions and dermo-epidermal detachment<ref name="pmid17075281">{{cite journal| author=French LE| title=Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding. | journal=Allergol Int | year= 2006 | volume= 55 | issue= 1 | pages= 9-16 | pmid=17075281 | doi=10.2332/allergolint.55.9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17075281 }}</ref> | ||
* Metabolic Panel: Electrolyte disturbances, | * Direct immunofloresence: Negative | ||
* Bacterial and | * Complete Blood Count: | ||
** [[Anemia]] and [[Lymphopenia]] are seen frequently<ref name="pmid2273103">{{cite journal| author=Roujeau JC, Chosidow O, Saiag P, Guillaume JC| title=Toxic epidermal necrolysis (Lyell syndrome). | journal=J Am Acad Dermatol | year= 1990 | volume= 23 | issue= 6 Pt 1 | pages= 1039-58 | pmid=2273103 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2273103 }}</ref> | |||
** Abnormal blood counts can be seen in case of superimposed bacterial infections | |||
* Metabolic Panel: Electrolyte disturbances, glucose, BUN, Cr, total protein, albumin (reduced), ALT, AST (increased) - abnormalities seen in cases of extensive disease with dehydration, bacteremia, [[Hypovolemic shock]] and [[Multiorgan failure]] | |||
* Bacterial and fungal cultures - taken from blood, mucosal surfaces | |||
* CRP, ESR, TNF-alpha, IL-6: Levels are typically elevated | * CRP, ESR, TNF-alpha, IL-6: Levels are typically elevated | ||
* Bronchoscopy | * [[Bronchoscopy]]: May be needed to detect mucosal lesions | ||
* HSV-IgM | * HSV-IgM | ||
* Mycoplasma IgM | * [[Mycoplasma]] IgM | ||
* ELISA-to detect other causative viruses (HAV, HBV, HCV, HIV, EBV, Rubella | * [[Enzyme linked immunosorbent assay (ELISA)|ELISA]]-to detect other causative viruses (HAV, HBV, HCV, HIV, EBV, Rubella) | ||
==References== | ==References== | ||
Latest revision as of 15:26, 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
SJS is mainly diagnosed through the clinical skin findings. However, a skin biopsy is helpful in making the definitive diagnosis. Other tests are done to either rule out the superimposed bacterial infection, measure disease severity or detect the causative agent or organism. Tests include CBC, BMP, Blood cultures, ESR, CRP, IL-6, ELISA for virus detection among others.
Laboratory Findings
Skin Biopsy is the only study that can make the definitive diagnosis of SJS. Other lab tests are done to detect superimposed bacterial infection or in cases of severe or extensive skin involvement that is more commonly seen in TEN as compared to SJS.
The first step after suspicion of SJS is identifying and discontinuing the offending agent.
Following tests are done[1][2]:
- Skin Biopsy (Urgent Frozen section): Lesional Biopsy and Perilesional Biopsy
- To confirm the diagnosis of Stevens-Johnson Syndrome and rule out other autoimmune skin conditions (for example Pemphigus Vulgaris, Bullous pemphigoid, GVHD, SSSS, Linear IgA bullous dermatosis)
- May show apoptosis and necrosis of keratinocytes along with lymphocytic infiltration of peri-vascular regions and dermo-epidermal detachment[3]
- Direct immunofloresence: Negative
- Complete Blood Count:
- Anemia and Lymphopenia are seen frequently[4]
- Abnormal blood counts can be seen in case of superimposed bacterial infections
- Metabolic Panel: Electrolyte disturbances, glucose, BUN, Cr, total protein, albumin (reduced), ALT, AST (increased) - abnormalities seen in cases of extensive disease with dehydration, bacteremia, Hypovolemic shock and Multiorgan failure
- Bacterial and fungal cultures - taken from blood, mucosal surfaces
- CRP, ESR, TNF-alpha, IL-6: Levels are typically elevated
- Bronchoscopy: May be needed to detect mucosal lesions
- HSV-IgM
- Mycoplasma IgM
- ELISA-to detect other causative viruses (HAV, HBV, HCV, HIV, EBV, Rubella)
References
- ↑ 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.
- ↑ Çekiç Ş, Canıtez Y, Sapan N (2016). "Evaluation of the patients diagnosed with Stevens Johnson syndrome and toxic epidermal necrolysis: a single center experience". Turk Pediatri Ars. 51 (3): 152–158. doi:10.5152/TurkPediatriArs.2016.3836. PMC 5047364. PMID 27738400.
- ↑ French LE (2006). "Toxic epidermal necrolysis and Stevens Johnson syndrome: our current understanding". Allergol Int. 55 (1): 9–16. doi:10.2332/allergolint.55.9. PMID 17075281.
- ↑ Roujeau JC, Chosidow O, Saiag P, Guillaume JC (1990). "Toxic epidermal necrolysis (Lyell syndrome)". J Am Acad Dermatol. 23 (6 Pt 1): 1039–58. PMID 2273103.