Serum Level of Granulocyte-macrophage Colony-stimulating Factor in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

Abstract

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse drug reactions. Activated T-cells secrete high amounts of cytokines that increase the expression and activity of keratinocytes, including granulocyte-macrophage colony-stimulating factor (GM-CSF). AIMS: The aims of this study were to evaluate the serum level of GM-CSF in SJS and TEN as well as the relationship between it and the progress of SJS and TEN. METHODS: This was a sectional descriptive study conducted at the National Hospital of Dermatology and Venereology, in Hanoi, Vietnam, from October 2017 to September 2019. Forty-eight SJS/TEN patients, 43 erythema multiforme (EM) patients, and 20 healthy controls (HCs) participated. GM-CSF levels were measured using the fluorescence covalent microbead immunosorbent assay (ProcartaPlex Immunoassay Panels kit, Thermo Fisher Scientific, USA). The Mann–Whitney U-test was used to compare serum SJS/TEN levels of the two groups. The Wilcoxon tests were used to compare quantitative variables before and after the treatment. Differences were considered to be statistically significant at p < 0.05. RESULTS: There were 19 SJS patients (39.5%) and 29 TEN patients (60.5%). The mean age was 49.3 years, range of 19–77 years. The male patients were 47.9%. The most common causative drugs were traditional medicine (29.1%), followed by carbamazepine (12.5%), and allopurinol (12.5%). On the day of hospitalization, the mean serum level of GM-CSF in the SJS/TEN group was 10.6 pg/mL, which was significantly higher than that of the EM group (p < 0.05) but not higher than that of the HCs group and was higher than that on the day of re-epithelialization (3.6 pg/mL) and the difference was statistically significant with p < 0.05. CONCLUSION: Serum GM-CSF level can be a good biomarker to evaluate the progress of SJS/TEN.