A Clinical Analysis Of 34 Cases With Severe Drug Eruption

Objective The aim of the study was to review and analyse the clinical manifestations, causative agents, treatment and prognosis of the severe drug eruption.Methods All hospitalized patients with severe drug eruption,including Erythema Multiforme Major/Stevens-Johnson Syndronme(EMM/SJS), Toxic Epidermal Necrolysis(TEN), Drug Rush with Eosinophilia and Systemic Symptoms(DRESS), Exfoliative Dermatitis(ED) during a five-year period from January 2010 to December 2015 were retrospectively reviewed.Results A total of 34 patients were hospitalized, and classified into SJS group(22),TEN group(8), DRESS(3), ED(1). The majority of the patients had mucutaneous eruptions associated with oral drug administration. Anticovulsants, allopurionl and antibiotics were the most common causative agents for the severe drug eruption, others including NSAIDS, Chinese medcine. The patients were from 12 to 88 years old and the most frequent age period was over 50 years old. Carbamazepine-induced and allopurionl-induced severe drug eruption were the most in our study, both of which had longer latent period, severe symptoms and multi-organ dysfunctional disturbance. TEN and DRESS should be given more concern not noly because of their severity and complications, but also the longer rash-controlling time and large dosage of glucorticosteroids in the treatment. In a word, it is necessary to give sufficient corticosteroids earlier. Intravenous immunoglobulin combined with corticosteroids was a good choice for the elders, people with chonic or acute diseases, and the ones with little response to the corticosteroids.Conclusion Patients presenting severe drug eruption usually develop fast, with various latent peroid, severe manifestations and multi-organ involved. It is important to give sufficient corticosteroids earlier. Combination therapy with corticosteroid and IVIG exhibited a tendency to reduce the mortality rate and complications. It is suggested that the prognosis is determined by the discontinue of suspect medications, the age of patient, the type of eruption, the early treatment, accompanied diseases, the dysfunction of some organs and the proper use of corticosteroid.