Stevens-Johnson syndrome laboratory findings

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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:

• Skin Biopsy: Lesional Biopsy and Perilesional Biopsy-To confirm the diagnosis of SJS 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
• Metabolic Panel: Electrolyte disturbances, Glucose, BUN, Cr, Total protein, ALT, AST- 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, EGD: may be needed to detect mucosal lesions
• HSV-IgM
• Mycoplasma IgM
• ELISA-to detect other causative viruses (HAV, HBV, HCV, HIV, EBV, Rubella,