ERYTHEMA MULTIFORME, STEVENS-JOHNSON SYNDROME AND TOXIC EPIDERMAL NECROLYSIS IN NORTHEASTERN MALAYSIA

Background Previous studies have reported that drugs and infections ar e common causes of erythema multiforme (EM) and Stevens-Johnson syndro me (SJS). Toxic epidermal necrolysis (TEN) is mainly related to drugs. No study has been conducted in Kelantan, the northeastern stale of Ma laysia, to assess these cutaneous reactions. Methods A retrospective s tudy of all hospitalized cases of EM, SJS, and TEN was conducted cover ing an 8-year period from 1987 to 1994. Results 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 probab le 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. Antiepile ptics were the commonest culprits, followed by antibiotics. One patien t 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%). Le ukocytosis was noted in 10 patients (34.5%), and nine patients (31.0%) had elevated liver transaminase enzymes. No significant correlation w as noted between these biochemical changes and cutaneous eruption. Sec ondary infections were observed in 11 patients (37.9%): Staphylococcus aureus was the commonest isolated organism. Conclusions This study sh ows that drugs remain the commonest culprit in SJS and TEN. Despite ad equate treatment, the mortality rate remains high, especially in TEN. These findings are similar to those of other reported studies.