Toxic Epidermal Necrolysis Overlap Research Articles

Amikacin induced Stevens Johnson syndrome and toxic epidermal necrolysis overlap: a rare case report

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe adverse drug reactions. They are characterized by necrosis and epidermal release in vesicobulosa skin, mucous orifice, and eyes, with more severe general symptoms. SJS/TEN-overlap syndrome is the term used to characterize situations where 10–30% of the body skin area is detached. TEN or SJS is one of the deadliest dermatological catastrophes. Despite being a rare condition, it frequently has a high death rate. Different types of purpuric macules or rounded patches with mucosal lesions are characteristic features of these type 3 hypersensitivity reactions. We are presenting a case of 50-year-old female patient brought to hospital on account of multiple black to red coloured raised lesions over body in the last 8 days. Patient was asymptomatic in the last 8 days after that patient noted red coloured lesions first over face followed by lower back, upper limb, lower limb followed by itching and Jiburning sensation all over the body. The patient had symptoms such as redness of eyes in the last 3-4 days, burning sensation and ulcers in mouth in the last 3-4 days. These symptoms developed day after she received amikacin. She was diagnosed with SJS-TEN overlap. This case highlights the precipitant of antibiotics for SJS. She was recovered completely after stopping the causative drug and treatment with Immunoglobulin with other symptomatic measures. The causative drug was found to be Amikacin and medicine taken for comorbid conditions like epilepsy, hypothyroidism and hypertension. Rarely, amikacin has been linked to a range of drug hypersensitivity reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, and overlap between the two conditions.

Pathogenesis and A Practical Guide to the Management of Steven-Johnson Syndrome & Toxic Epidermal Necrolysis

Steven Johnson Syndrome (SJS) and Toxic Epidermal necrolysis are rare dermatological emergencies that are associated with a high degree of morbidity and mortality [1]. They are considered to be severe blistering conditions that portray an image of diffuse epidermal necrolysis in association with sloughing of the skin. SJS and TEN are effectively the same disease with the main difference being the percentage of body surface area involved. It is widely accepted that SJS belongs to the below 10% body surface area category and TEN to the more than 30% category. A Steven Johnson syndrome and Toxic Epidermal Necrolysis overlap exists when the body surface area affected is between 10 percent and 30 percent [2]. The causes of both conditions within this spectrum are most likely drug related, however certain infections can also trigger SJS/TEN but this is less likely. In a substantial number of cases the cause is idiopathic [3]. The main grading system is the SCORTEN criteria, which can also provide more information regarding prognosis and mortality [4]. Management of this condition is highly controversial with no clear guidelines but there is a wide agreement that patients should be managed in a burns unit with intravenous fluids and protection from secondary infections. Stopping all medications and investigating for the cause is important unless there is clear benefit from any single medication.

Drug Reaction with Eosinophilia and Systemic Symptoms Syndrome with Toxic Epidermal Necrolysis: Overlap in an HIV Seropositive Male with Diffuse Large “B” Cell Lymphoma – A Rare Case Report

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe drug-induced hypersensitivity reaction with varied presentations. We report a rare case of DRESS syndrome with toxic epidermal necrolysis (TEN) overlap associated with non-Hodgkin lymphoma (NHL). A 52-year-old male with retroviral disease presented with fever and diffuse skin peeling with mucosal erosions. The patient was on antitubercular therapy (ATT) for 1 month for suspected tubercular cervical lymphadenitis. He had facial edema, extensive skin tenderness, and denudation with a positive Nikolsky’s sign, icterus, hepatosplenomegaly and multiple enlarged immobile nontender cervical, and axillary and inguinal lymph nodes. Investigations showed leukocytosis with hepatic and renal dysfunction. Skin histopathology was consistent with TEN. Based on Registry of Severe Cutaneous Adverse Reaction criteria, a diagnosis of ATT-induced DRESS with TEN overlap was made. Cervical lymph node biopsy and immunohistochemistry confirmed diffuse large B-cell NHL. ATT was withheld and the patient was treated with systemic steroids and assessed for initiation of chemotherapy. The profound immunological dysregulation in individuals with retroviral disease leads to varied clinical presentations, increasing the chances of diagnostic errors, and culminating in challenging scenarios. Therefore, seemingly innocuous symptoms and signs warrant thorough evaluation. Sound clinical acumen and prompt investigations for unusual causes such as malignancies can improve outcomes by aiding accurate diagnosis as well as avert untoward complications such as DRESS syndrome/TE.

Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis Overlap in Pediatric Patients With a Focus on Newer Antiepileptic Drugs: A 25-year Retrospective Study at a Single Tertiary Care Center

Toxic Epidermal Necrolysis and Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis Overlap in Pediatric Patients With a Focus on Newer Antiepileptic Drugs: A 25-year Retrospective Study at a Single Tertiary Care Center

Acetaminophen induced Stevens Johnson syndrome - Toxic Epidermal Necrolysis Overlap Syndrome: A rare Adverse Reaction

Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are hyper sensitive life - threatening rare dermatological reactions. In SJS - TEN overlap syndrome, the extent and severity of epidermal detachment is 10- 30%. Drugs like sulfonamides, nonsteroidal anti- inflammatory agents, antibiotics and anticonvulsants are the commonest precipitants. Here, we present a rare case of SJS - TEN overlap syndrome in a previously normal 11 years old girl after acetaminophen intake for fever. This case report is intended to make paediatricians aware that the adverse reaction like SJS - TEN overlap syndrome can develop with a drug like acetaminophen which is supposed to be the safest antipyretic in paediatrics.

Oxcarbazepine-induced stevens johnson syndrome and toxic epidermal necrolysis overlap

Oxcarbazepine-induced stevens johnson syndrome and toxic epidermal necrolysis overlap

Retrospective analysis of cases with Stevens-Johnson syndrome/toxic epidermal necrolysis: A case series of 20 patients

Background: Stevens-Johnson syndrome (SJS)/ toxic epidermal necrolysis (TEN) are rare, acute, severe cutaneous hypersensitivity reactions usually triggered by medications. They are classified by the extent of the detached skin surface area. Objective: We aimed to retrospectively evaluate the sociodemographic, clinical, therapeutic, and prognostic characteristics of SJS/TEN cases diagnosed between January 2015 and December 2020 in our centre. Materials and Methods: All the data regarding patient characteristics were obtained retrospectively. The SCORe of Toxic Epidermal Necrolysis (SCORTEN) was used to predict disease severity and mortality rates. Results: Out of 20 patients (14 females, 6 males), eight (40%) were evaluated as TEN, three (15%) as SJS/ TEN overlap, and nine (45%) as SJS. The mean age was 39.2 ± 27.92 years. A higher frequency of systemic antibiotic use was found in cases of SJS/TEN overlap or TEN compared to SJS cases during patients’ follow-up after the diagnosis (P = 0.006). The most common responsible drug was allopurinol (25%). While the estimated mortality in patients with SCORTEN values of 4 and 5 was 58.3% and 90.0%, the mortality observed in our cohort was 50% and 100%, respectively. In terms of complications, ocular problems were the most common ones. Ophthalmic sequelae were observed in 15 patients during the follow-up period, the most common belonging to the cornea. Conclusion: In conclusion, early diagnosis, immediate discontinuation of suspected drugs, and good clinical care are among the most crucial treatment steps in the treatment of SJS/TEN. In addition, multidisciplinary management of the disease is vital in preventing the development of long-term sequelae in survivors.

Concomitant Nicolau’s and Stevens-Johnson syndrome—Toxic epidermal necrolysis overlap after diphtheria, pertussis, tetanus vaccination: An unusual presentation in a young child

Diphtheria, pertussis, tetanus (DPT) is a live attenuated vaccine included in the national immunization schedule. Common adverse effects of this vaccine include localized pain, erythema, and high-grade fever. Rarely, it can cause severe localized or generalized reactions such as Nicolau’s syndrome (NS), erythema multiforme (EM), Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN). A 6-year-old boy developed severe pain over left gluteal region, immediately after DPT vaccine, followed by local ulceration. Two days later, he also developed mucocutaneous lesions. Clinical features were consistent with NS and SJS-TEN overlap. Concomitant NS with SJS-TEN overlap after DPT vaccine is rare and has not been reported earlier.

The Profiles of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) Patients in Tertiary Hospital

Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe eruptive skin reactions that can cause death. The incidence of SJS and TEN cases in the United States is 1.5–9.6 per 1,000,000 per year. Drugs are the primary etiology of SJS and TEN. Some drugs are at high risk and used frequently. The SJS and TEN mortality rates were relatively high, with SJS 4.8%, SJS / TEN overlap 19.8%, and TEN 14.8%. In Indonesia, there are lack of studies on the SJS and TEN. This study is needed to determine the epidemiological profile of SJS and TEN. Purpose: This study aimed to describe SJS and TEN patients' profiles. Methods: Drug-induced SJS and TEN cases from January 2016 to December 2019 were evaluated from the medical records patients' profile, incidence, suspected drugs, risk factors, and comorbidities of SJS and TEN were described. Result: There were 28 SJS and TEN patients, comprising of 24 SJS patients (85.7%), 3 TEN patients (10.7%), and 1 SJS overlapping TEN patients (3.5%). The most common suspected drugs were paracetamol (22.2%), carbamazepine (20.4%), cefadroxil (8.8%), and ciprofloxacin (8.8%). Women (53.5%) experienced more severe drug eruptions than men (46.4%). The largest age group was 25–44 years (35.7%). Most comorbidities were epilepsy (21%), diabetes (15.7%), hypertension (15.7%), and stroke (15.7%). Conclusion: The most common manifestation was SJS with paracetamol as the most common suspected drug, followed by carbamazepine.

Cutaneous adverse reactions associated with antiseizure medication: clinical characteristics and implications in epilepsy treatment.

To describe the clinical characteristics of cutaneous adverse reactions and cross-sensitivity induced by antiseizure medications and compare the pattern of use of antiseizure medications in patients with epilepsy according to skin rash history. We analysed patients with a history of skin rash presenting for up to 12 weeks after initiating antiseizure medication. The history of skin rash was verified by medical charts, interviews, and identification of skin lesions by patients based on illustrative images. The minimum follow-up period was eight months. The control group comprised epilepsy patients with regular antiseizure medication use for at least 12 weeks without skin rash. We included 109 cases and 99 controls. The median (interquartile range) period from the index rash was six years (2-11). Carbamazepine was the trigger medication in 48% of cases and induced skin rashes in all patients with cross-sensitivity and carbamazepine exposure. Stevens-Johnson syndrome, toxic epidermal necrolysis, or drug reactions with eosinophilia and systemic symptoms affected 36% of cases. Carbamazepine- or oxcarbazepine-induced maculopapular exanthema occurred earlier (median: one week) than that induced by other antiseizure medications (median: three weeks) (p=0.006). Cross-sensitivity was more common in patients with at least one episode of Stevens-Johnson syndrome (29%) and Stevens-Johnson/toxic epidermal necrolysis overlap (50%) than in patients with maculopapular exanthema (8%) (p=0.01). Although most cases were mild, the pattern of antiseizure medication use differed from that of controls, with a lower proportion of antiseizure medication typically associated with severe cutaneous adverse reactions (carbamazepine, phenytoin, phenobarbital, primidone, oxcarbazepine, and lamotrigine) (p<0.001). Most cases exposed to high-risk medication, however, did not develop cross-sensitivity. Cutaneous adverse reaction history may influence antiseizure medication use. Cross-sensitivity is more common in severe cases and most patients are affected by mild, self-limited skin rashes. Further research should consider the relevance of mild skin rashes in lifelong epilepsy treatment.

Case Report: Suspected Case of Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis Overlap Due to Ursodeoxycholic Acid

Stevens–Johnson syndrome and toxic epidermal necrolysis are well-known severe cutaneous adverse reactions, with &gt;100 medications previously implicated, most frequently sulfonamide antibiotics. Ursodeoxycholic acid (UDCA), normally present in human bile at a low concentration, is used for the treatment of various cholestatic disorders. Reports of UDCA causing cutaneous complications are, however, rare. The present report describes a suspected case of UDCA-induced Stevens–Johnson syndrome–toxic epidermal necrolysis overlap in a 24-year-old female, admitted with a whole-body maculopapular rash with oromucocutaneous ulceration and skin desquamation. The patient was managed with supportive care, including fluid and electrolyte replacement, corticosteroids, antibiotics, antihistamines, and intravenous Ig. Early identification, prompt intervention with effective care, and support are the key action points in these severe cutaneous adverse reactions.

Survival after Stevens‒Johnson Syndrome or Toxic Epidermal Necrolysis: A United Kingdom‒Based Cohort Study

Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare mucocutaneous adverse drug reactions (Ferrandiz-Pulido and Garcia-Patos, 2013; Frey et al., 2017a, 2017b; Harr and French, 2012; Hsu et al., 2016; Martín-Merino et al., 2015; Mockenhaupt, 2012; Mockenhaupt et al., 2005). In the European Registry of Severe Cutaneous Adverse Reactions, 23% of patients died within 6 weeks after the onset of SJS and/or TEN (SJS: 12%, SJS and TEN overlap: 29%, TEN: 46%, 2003–2007). After 1 year, 34% of patients had died (Sekula et al., 2013).

Stevens-Johnson syndrome and toxic epidermal necrolysis overlap associated with alternative medicine: A case report

Stevens-Johnson syndrome and toxic epidermal necrolysis overlap associated with alternative medicine: A case report - IJPCA- Print ISSN No: - 2394-2789 Online ISSN No:- 2394-2797 Article DOI No:- 10.18231/j.ijpca.2019.010, International Journal of Pharmaceutical Chemistry and Analysis-Int J Pharm Chem Anal

Stevens Johnson Syndrome: Toxic Epidermal Necrolysis Overlap Due to Pantoprazole: Report of a Fatality

Proton pump inhibitors (PPIs) are widely prescribed and generally well-tolerated. Severe cutaneous hypersensitivity reactions such Stevens Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but potentially life threatening, complications of PPI use. Omeprazole, esomeprazole, lansoprazole, and pantoprazole have all been implicated in a small number of cases of SJS or TEN. Here we present the first documented fatality related to severe desquamating hypersensitivity reaction to pantoprazole. A 74-year-old woman with chronic obstructive pulmonary disease, peripheral vascular disease, and hypertension presented to the emergency department with a painful skin eruption. One month prior, an admission for gallstone pancreatitis was complicated by melena. Endoscopy showed severe erosive distal esophagitis and several small duodenal ulcers. She was discharged after laparoscopic cholecystectomy on sucralfate for 2 weeks and pantoprazole 40mg PO twice daily. Her home medications, unchanged for more than a year, were continued: aspirin 81mg daily, vitamin D3 2000U daily, donepezil 10mg daily, hydrochlorothiazide 25mg daily, lisinopril 5mg daily, and metoprolol tartrate 25mg twice daily. On admission to the burn unit she was found to have a generalized morbilliform eruption over her face, trunk, bilateral upper and lower extremities, and labia majora, with erythematous flaccid vesicles and bullae and multiple open areas of desquamation with positive Nikolsky sign (Image 1). There was involvement of the oral mucosa and conjunctiva. Sloughing progressed until hospital day 8, when TBSA was estimated at 30% (Image 2). Testing for Mycoplasma pneumoniae was negative, liver enzymes, renal function, and complete blood count were normal and there were no fevers or other symptoms on presentation to suggest viral infection. There were no other potential offending medications in the month prior to presentation. Skin biopsies showed full thickness epidermis with partial necrosis, consistent with SJS. On hospital day 9 the patient developed severe sepsis of unknown source and passed away the following day. PPIs are commonly used medications, and intolerance remains rare. However, here we describe a case of an elderly woman appropriately prescribed pantoprazole for gastrointestinal hemorrhage who experienced a fatal hypersensitivity reaction. All prescribers of PPIs should be aware of this rare but serious potential reaction.Figure: Initial presentation. Intact and ruptured bullae on right posterolateral thigh.Figure: Hospital day 8. Right flank, buttock, and thigh.

Incidence, causative drugs, and economic consequences of drug-induced SJS, TEN, and SJS-TEN overlap and potential drug-drug interactions during treatment: a retrospective analysis at an Indonesian referral hospital.

BackgroundStevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute life-threatening adverse drug reactions (ADRs) that are commonly caused by medications. Apart from their contribution to morbidity and mortality, these diseases may also present substantial consequences on health care resources. In this study, we aimed to identify the incidence, causative drugs, and economic consequences of these serious ADRs and potential drug–drug interactions (DDIs) during treatment.MethodsA retrospective study that included 150 patients diagnosed with drug-induced SJS, SJS–TEN overlap, and TEN, from 2009 to 2013 in a referral hospital in West Java Province, Indonesia, was conducted to analyze the causative drugs, cost of illness (COI) as a representation of economic consequences, and potential DDIs during treatment.ResultsThe results showed that analgesic–antipyretic drugs were the most frequently implicated drugs. The COIs for SJS, SJS–TEN overlap, and TEN patients were 119.49, 139.21, and 162.08 US dollars per day, respectively. Furthermore, potential DDIs with several therapeutic medications and corticosteroids used to treat SJS, SJS–TEN overlap, and TEN were also identified.ConclusionThis study showed that analgesic–antipyretic was the major causative drug which contributed to SJS, SJS–TEN overlap, and TEN. Furthermore, our results also showed that SJS, SJS–TEN overlap, and TEN may cause considerable financial consequences to patients.

A rare case of oxcarbazepine induced Stevens Johnson Syndrome: toxic epidermal necrosis overlap

Oxcarbazepine is a closely related analogue of carbamazepine and is useful in the monotherapy of seizures with an improved toxicity profile. Its clinical safety has been recently put under scrutiny as evidence has emerged about its adverse drug reactions and it is increasingly being reported to cause cutaneous drug eruptions. Here we report a rare case of oxcarbazepine induced Stevens Johnson - toxic epidermal necrolysis overlap.

Syndroma Stevens-Johnson - toxic epidermal necrolysis overlap associated with carbamazepine in patient with secondary epilepsy caused by brain tumor (Glioblastoma multiforme)

Syndroma Stevens-Johnson - toxic epidermal necrolysis overlap associated with carbamazepine in patient with secondary epilepsy caused by brain tumor (Glioblastoma multiforme)

New insights in Stevens Johnson syndrome/ toxic epidermal necrolysis syndrome

Stevens Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening cutaneous severe adverse reactions (SCAR) most frequently induced by a drug hypersensitivity. The clinical manifestations seem to be related either to a particular group of drugs, such as antibacterial sulfonamides, anticonvulsant agents, allopurinol, non-steroidal anti-inflammatory drugs (NSAIDs), aminopenicillins and quinolones, as well as to the ethnic/genetic background of the affected individual. A relevant problem in these subjects is the selection of a potentially tolerated drug that is less likely to induce a relapse of the reaction on the basis of cross-reactivity. Aim of the present study was to analyse a population of 16 patients that were treated in the burn/intensive care department for a SJS/TEN reaction, and determine the drugs that were tolerated after the reaction with respect to the culprit substances. The diagnosis was performed on the basis of the clinical and histological features according to the RegiSCAR classification and the first step was withdrawal of the offending drug. Among the 16 cases, we found 5 cases of SJS, 8 cases of TEN, and 3 cases of SJS/ TEN overlap. Of the 16, 4 patients were male and 12 were female, age 14-92 years (average 57.1 years; median 63.5 years). A total of 12 drugs were found as suspected causative agents. In 3 cases multiple drugs were suspected, whereas in 13 cases a single drug was implicated. Antimicrobials including amoxicillin, levofloxacin, trimethoprimsulfamethoxazole, vancomycin (8/16; 50 %) were the most commonly associated agents followed by antiseizure drugs (4/16; 25 %), NSAIDs (3/16; 18.75 %), benzodiazepines (2/16; 12.5 %) and allopurinol (1/16; 6.25 %). The most common complications noted were secondary infections (15/16; 93.75 %) and septicemia (11/16; 68.75 %). Mortality rate was 18,75 % (3/16). Interestingly patients with reactions to quinolones tolerated glycopeptides and carbapenems. Also, a patient with reaction to amoxicillin tolerated carbapenems. One of the 4 patients with reaction to anticonvulsant tolerated levetiracetam, 4/4 benzodiazepines, and 1/4 haloperidol. A patient with suspected reaction to acetaminophen (amoxicillin was the other involved drug) tolerated nimesulide and carbapenems. A patient with reaction to oxcarbazepine tolerated diazepam. We conclude that a competent burn centre staff can guarantee the successful management of the patients.

Levofloxacin induced Stevens‐Johnson syndrome/ toxic epidermal necrolysis overlap syndrome: case reports

Fluoroquinolones are widely used because of their broad spectrum of activity. Their benefit-risk profile needs careful evaluation as they can induce T cell-dependent reactions including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). Here we present two rare cases of SJS/TEN overlap syndrome and SJS caused by levofloxacin. Case 1. A 70-year-old woman with a history of chronic obstructive pulmonary disease was treated with levofloxacin for acute bronchitis. After taking medications for 10 days she complained of generalized skin eruptions and mucosal erosions. On the day of admission in the burn intensive care department 28 % of her body surface was covered by rash, blistering and epidermal peeling; 65 % of body surface presented dusky red skin. Levofloxacin was stopped and our patient was treated with topical solution to keep the wounds moist, fluid replacement, well balanced nutrition, systemic corticosteroids and intravenous immune globulin (IVIG). We also administrated teicoplanin because of S. aureus infection of central i.v. catheter confirmed by a positive culture. She was subsequently treated with meropenem because of a Klebsiella pneumoniae urinary tract infection. The main laboratory findings were: anemia, leukocytosis and increased CRP levels. The diagnosis was performed on the basis of clinical and histological features. Gradually her symptoms improved and the epidermal peeling also subsided. Case 2. A 72-year-old woman was referred to our department with multiple skin lesions involving more than 50 % of the total body surface area occurred after 2 weeks of starting levofloxacin treatment for pneumonia. She developed high fever and had the appearance of a severe burn patient. Laboratory analysis showed anaemia, leukocytosis, hypoalbuminaemia and elevated procalcitonin and CRP. The levofloxacin treatment was stopped immediately and replaced with teicoplanin and meropenem. Subsequently because of A. baumanii complex infection of the central i.v. catheter she was treated also with colistin. Our management included IVIG treatment, intravenous glucocorticoids, proper fluid balance, attention to nutritional status and pain relief. The skin lesions healed within 3 weeks and the patient left our department in good general condition.

The role of intravenous immunoglobulin in toxic epidermal necrolysis: a retrospective analysis of 64 patients managed in a specialized centre

Toxic epidermal necrolysis (TEN) is a severe cutaneous adverse drug reaction with a mortality of 40%. Intravenous immunoglobulin (IVIg) is widely used as a specific treatment for this reaction, although evidence of its benefit is conflicting. We sought to evaluate whether the use of IVIg improved mortality in patients with Stevens-Johnson syndrome (SJS)/TEN overlap and TEN. We retrospectively analysed data for 64 patients with SJS/TEN overlap and TEN who were treated with IVIg at a single referral centre. The primary outcome analysed was in-hospital mortality. Predicted mortality was calculated based on severity-of-illness score for TEN (SCORTEN) values. Secondary analyses of survival based on IVIg dosages and prior corticosteroid exposure were also performed. There were 28 cases of SJS/TEN overlap and 36 cases of TEN, with a mean SCORTEN value of 2·6. The mean dose of IVIg given was 2·4 g kg(-1) and the mean delay from the onset of epidermal detachment to administration of IVIg was 3·2 days. There were 20 deaths (31%) in our cohort. The standardized mortality rate was 1·10 (95% confidence interval 0·62-1·58). Subgroup analysis comparing survivors and nonsurvivors showed a higher SCORTEN in nonsurvivors (3·4 vs. 2·2). There were no differences with regard to the dosage, delay and duration of IVIg administration. When stratified according to dosage, there was no mortality difference between patients who receive high-dose (≥ 3 g kg(-1) ) vs. low-dose (< 3 g kg(-1) ) IVIg. This study shows that the use of IVIg does not yield survival benefits in SJS/TEN overlap and TEN, even when corrected for IVIg dosages.