Plastic Surgery and Burns Unit, Centro Hospitalar São João, Porto, Portugal.
Stevens-Johnson syndrome (SSJ) and toxic epidermal necrolysis (TEN) correspond to an acute and rare life-threatening mucocutaneous reaction. We describe the etiology, length of stay, comorbidities and mortality of TEN in our hospital in a retrospective study of 12 years. Twenty-one patients were included in the study. The mean age was 66 years: 57.1% were females. One third had mucosal surface involvement. Median TBSA of epidermal detachment was 66% on day 1. Forty-two per cent had a SCORTEN at admission of 3 and 28.6% had a SCORTEN of 4, which performs 70.6% with SCORTEN ≥5. The most common causes of SJS/TEN in this study were antibiotics. There were a total of 15 deaths (71.4%). All the patients in the antibiotic group died. Patients who needed invasive ventilation had higher mortality (91%) than the non-invasive ventilation group (50%) and the group on spontaneous ventilation (42.8%). The most common complications were sepsis (53%) and renal failure (23%). Highest mortality due to sepsis was in the antibiotic group. When SCORTEN score was calculated for each patient, statistical evaluation showed an increase in mortality with increasing final score. The most crucial interventions are discontinuation of the causative drug and immediate referral to a burn unit, which helps in early diagnosis and decreases mortality. Our study provides insights into the confirmation of the risk of SJS/TEN as well as its treatment. When SSJ/TEN is caused by antibiotics, the suspicion of developing fatal sepsis should be high regardless of the patient's medical condition.
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