Kamaliah M D, Zainal D, Mokhtar N, Nazmi N
Department of Medicine, School of Medical Sciences, Hospital University Science Malaysia, Kubang Kerian, Kota Bharu, Kelantan, Malaysia.
Int J Dermatol. 1998 Jul;37(7):520-3. doi: 10.1046/j.1365-4362.1998.00490.x.
Previous studies have reported that drugs and infections are common causes of erythema multiforme (EM) and Stevens-Johnson syndrome (SJS). Toxic epidermal necrolysis (TEN) is mainly related to drugs. No study has been conducted in Kelantan, the northeastern state of Malaysia, to assess these cutaneous reactions.
A retrospective study of all hospitalized cases of EM, SJS, and TEN was conducted covering an 8-year period from 1987 to 1994.
There were four cases (13.8%) of EM, 22 cases (75.9%) of SJS, and three cases (10.3%) of TEN. Drugs as a definitive cause was observed in one case (25%) of EM, 12 cases (54.5%) of SJS, and two cases (66.7%) of TEN. Drugs as a probable cause was observed in seven cases (31.8%) of SJS and one case (33.3%) of TEN. The male to female ratio was equal in EM and SJS. Antiepileptics were the commonest culprits, followed by antibiotics. One patient died of SJS and one patient died of TEN, giving mortality rates of 4.5% and 33.5% respectively. Fever was noted in 18 patients (62.1%). Leukocytosis was noted in 10 patients (34.5%), and nine patients (31.0%) had elevated liver transaminase enzymes. No significant correlation was noted between these biochemical changes and cutaneous eruption. Secondary infections were observed in 11 patients (37.9%): Staphylococcus aureus was the commonest isolated organism.
This study shows that drugs remain the commonest culprit in SJS and TEN. Despite adequate treatment, the mortality rate remains high, especially in TEN. These findings are similar to those of other reported studies.
既往研究报道，药物和感染是多形红斑（EM）和史蒂文斯-约翰逊综合征（SJS）的常见病因。中毒性表皮坏死松解症（TEN）主要与药物有关。马来西亚东北部的吉兰丹州尚未开展过评估这些皮肤反应的研究。
对1987年至1994年8年间所有住院的EM、SJS和TEN病例进行回顾性研究。
有4例（13.8%）EM、22例（75.9%）SJS和3例（10.3%）TEN。在1例（25%）EM、12例（54.5%）SJS和2例（66.7%）TEN中观察到药物为明确病因。在7例（31.8%）SJS和1例（33.3%）TEN中观察到药物为可能病因。EM和SJS的男女比例相等。抗癫痫药是最常见的致病因素，其次是抗生素。1例SJS患者死亡，1例TEN患者死亡，死亡率分别为4.5%和33.5%。18例患者（62.1%）出现发热。10例患者（34.5%）出现白细胞增多，9例患者（31.0%）肝转氨酶升高。这些生化变化与皮疹之间未发现显著相关性。11例患者（37.9%）出现继发感染：最常见的分离菌是金黄色葡萄球菌。
本研究表明，药物仍是SJS和TEN最常见的致病因素。尽管进行了充分治疗，但死亡率仍然很高，尤其是在TEN中。这些发现与其他报道的研究结果相似。
