Spectrum of gastrointestinal involvement in Stevens - Johnson syndrome

Abstract

Stevens - Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) is a severe adverse drug reaction associated with involvement of skin and mucosal membranes, and carries significant risk of mortality and morbidity. Mucus membrane lesions usually involve the oral cavity, lips, bulbar conjunctiva and the anogenitalia. The oral/anal mucosa and liver are commonly involved in SJS or TEN. However, intestinal involvement is distinctly rare. We herein review the current literature regarding the gastrointestinal involvement in SJS or TEN. This review focuses mainly on the small bowel and colonic involvement in patients with SJS or TEN.

Colonic Involvement of Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: A Rare Cause of Gastrointestinal Bleeding

“…Treatment with high-dose corticosteroids and IVIG should be considered, although monotherapy with systemic corticosteroids is not recommended because of the lack of evidence to support their benefit and potential risks including higher rates of infection and complications. 11,12…”

“…Although anal and esophageal involvement has been reported, colonic involvement is rare with only 13 cases described in the literature. 4–11 Intestinal SJS/TEN is characterized by severe diarrhea or delayed gastrointestinal (GI) bleeding, often occurring 2–3 weeks after the initial appearance of skin lesions. 4–11 There are no evidence-based treatment algorithms for management of SJS/TEN.…”

“…4–11 Intestinal SJS/TEN is characterized by severe diarrhea or delayed gastrointestinal (GI) bleeding, often occurring 2–3 weeks after the initial appearance of skin lesions. 4–11 There are no evidence-based treatment algorithms for management of SJS/TEN. Adjuvant therapies including intravenous immunoglobulin (IVIG), cyclosporine, and anti-TNF-α agents remain controversial.…”

Acute pancreatic injuries: A complication of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with cytotoxic immunocell activation

“…4 Among them, gastrointestinal involvement has the highest incidence rate and generally presents with transient liver enzyme increases and gastrointestinal tract epithelial necrosis. [5][6][7][8] However, pancreatic injuries related to SJS/TEN have been rarely reported. 9,10 Accumulating evidence has shown that SJS/TEN is mediated by cytotoxic T lymphocytes and, to a lesser extent, natural killer cells.…”

<p>Severe Gastrointestinal Involvement in Pediatric Stevens-Johnson Syndrome: A Case Report and Review of the Literature</p>

“…Among adults, gastrointestinal manifestations are a marker of disease severity with an estimated mortality of 52% among cases with involvement beyond the esophagus. [2][3][4][5][6][7][8][9][10][11][12][13][14][15] We present the case of a boy who presented with the typical cutaneous and ocular manifestations of SJS, and subsequently developed severe diarrhea with diffuse involvement of the esophagus, small bowel, and colon. This patient is the first reported pediatric case of SJS/TEN in which both the upper and lower gastrointestinal tracts are involved.…”