Long-term sequelae of DRESS and SJS/TEN: A prospective comparative study

Abstract

As two distinct forms of severe cutaneous adverse reactions (SCARs), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) and drug reaction with eosinophilia and systemic symptoms (DRESS) demonstrate different immunological mechanisms and clinical manifestations. Based on previous reports, they also exhibit unique patterns of long-term complications after clinical resolution. To compare the immune response during the acute stage and incidence rates of long-term sequelae in the two diseases, we prospectively collected cases of DRESS and SJS/TEN from 2010 to 2015. In total, 61 DRESS patients and 36 SJS/TEN patients were included. Lymphocyte subset analysis by flow cytometry in 30 of 61 DRESS cases and 20 of 36 SJS/TEN cases revealed a significant decrease in CD19+ B cells in DRESS group but not in SJS/TEN group. The average CD4:CD8 ratio was 1.06 ± 0.63 in DRESS group and 1.32 ± 0.64 in SJS/TEN group. Among the DRESS group, 7 patients were found to have 9 complications, including autoimmune thyroiditis (n = 2), thyroid papillary carcinoma (n = 1), newly diagnosed type 1 (n = 1) or type 2 diabetes mellitus (n = 2), progression of pre-existing chronic kidney disease to end stage renal disease (n = 2) and epilepsy with psychomotor retardation (n = 1). For patients who had recovered from SJS/TEN, ocular problems and cutaneous problems were the most common sequelae. In conclusion, both DRESS and SJS/TEN patients should be carefully followed up for the risk of developing long-term sequelae.