Background : Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare immune-mediated severe cutaneous adverse reactions with incidence rate of 0.05 to 2 persons per million populations per year. Drugs are the most commonly implicated in 95% of cases. Aims : To audit the causative drugs, clinical outcome, and cost of management in SJS, TEN, and SJS-TEN overlap. Setting and Design: Tertiary care hospitals-based multicentric retrospective study (case series). Materials and Methods : Indoor case papers of SJS, TEN, and SJS-TEN overlap admitted between January 2006 and December 2009 in four tertiary care hospitals of Gujarat were scrutinized. Data were collected for demographic information, causative drugs, investigations, treatment given, duration of hospital stay, time interval between onset of symptoms and drug intake, clinical outcome, and complications. Data were analyzed to find out proportion of individual drugs responsible, major complications, and clinical outcome in SJS, TEN, and SJS-TEN overlap. Total cost of management was calculated by using cost of drugs, investigations, and consumables used during entire hospital stay. Statistical Analysis : One-way Analysis of Variance followed by Tukey-Kramer multiple comparison test was used for comparison of incubation period, duration of hospital stay, and cost of management. Results : Antimicrobials (50%), nonsteroidal anti-inflammatory drugs (22.41%), and antiseizure drugs (18.96%) were the most commonly associated groups. Nevirapine (28.12%) was the most common drug. Antiseizure drugs were more often associated with serious form of adverse reaction (TEN: 81.8%) than other drugs. Duration of hospital stay (20.6 vs 9.7 days) and cost of management (Rs 7 910/- vs Rs 2 460/-) were significantly higher in TEN than SJS (P=0.020 and P<0.001, respectively). Time duration between drug intake and onset of symptoms (17.7 vs 27.5 days) was nonsignificantly lower in TEN as compared with SJS. Secondary infection (28.12%) was the most common complication noted. Mortality rate was 15.6% among all cases; 9% in SJS and 26.7% in TEN. Conclusion : Antimicrobial drugs are the most commonly implicated drugs and cost of managing these adverse drug reactions is higher than other serious ADRs.

多形红斑(erythema multiforme,EM)患者具有同心圆形状的“靶形”皮损,但无黏膜损害和发热等系统症状.Stevens-Johnson综合征(Stevens-Johnson syndrome,SJS)患者不仅有皮肤的“靶形”损害,还有黏膜受累和系统症状,曾称为重症多形红斑(erythema muhiforme majus,EMM)、重型多形渗出性红斑(erythema exsudativum multiforme majus).一些学者认为EMM和SJS为同一种病,也有学者认为EMM和SJS不是一种病,SJS多由药物引起,可进展为中毒性表皮坏死松解症(TEN),而EMM是EM的重型,不会进展为TEN,二者的病因、发病机制、临床表现和治疗均不同[1-3].

正患者,男,36岁,因右上臂 被玻璃划伤,肿痛3 d后来我院门诊就诊。体检:T 37．2℃,P 85次／min,R 23次／min, BP130／75 mmHg。实验室检查:WBC:12．5×109／L、N:0．8、L:0．2。体检:一般状况良好,心肺功能正常,右上臂伤口肿胀、发红、有淡黄色脓 液,压痛明显。诊断为伤口感染,治疗

篇首： 1 临床资料 患儿,男,3岁,体重14 kg,因左耳疼痛由母亲带领于2006-11-24来兰州军区乌鲁木齐总医院耳鼻喉科门诊就诊.根据病史及检查,医生初步诊断为中耳炎.