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DILI rarely associated with SJS/TEN

Researchers in India found that an association between drug-induced liver injury and Stevens-Johnson syndrome/toxic epidermal necrolysis was rare, according to published findings.

“Our study is one of the few efforts to investigate the characteristics of [drug-induced liver injury] when associated with [Stevens-Johnson syndrome/toxic epidermal necrolysis]. Our experience showed that a small number of drugs were responsible for a majority of cases,” Harshad Devarbhavi, MD, of the department of gastroenterology at St. John’s Medical College Hospital, Bangalore, India, and colleagues wrote.

Using the drug-induced liver injury (DILI) registry, the researchers identified 36 consecutive cases of Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) from 748 patients with DILI seen in a single center in India from 1997 to March 2014.

Overall, antiepileptic drugs (n = 17), sulfonamides (n = 7) and antiretroviral drugs, such as nevirapine (n = 6), were accountable for a majority of the cases of SJS/TEN. The mortality rate among the entire cohort was 36% (n = 13), which increased to 45.5% when the patient had evidence of jaundice. In addition to jaundice, severe liver dysfunction was also indicated by high bilirubin, a MELD score of 20 and an international normalized ratio of 2.1, according to the research.

The mortality rate was lower in children (11%, n = 1) and patients with HIV (12.5%, n = 1). Mortality was associated with sepsis and multi-organ failure was related to both liver and skin-related injuries.

In an accompanying editorial, Einar Björnsson, MD, PhD, division of gastroenterology and hepatology, The National University Hospital of Iceland, and Jon Hjaltalin Ólafsson, MD, PhD, department of dermatology, University of Iceland, discussed the importance of collaboration between hepatologists and dermatologists to determine any association between DILI and SJS/TEN.

“This important collaboration between hepatologists and dermatologists in India has resulted in an important contribution to the fields of both DILI and severe cutaneous reactions. Concomitant involvement of the liver and SJS/TEN is associated with poor prognosis, which illustrates the clinical importance of this disorder. Further studies are needed to identify patients at particular risk for this type of [adverse drug reaction],” the researchers wrote.

Devarbhavi and colleagues concluded: “Some patients with DILI also develop SJS/TEN from the same medication. Those patients who develop ‘severe DILI’ in combination with SJS/TEN have poor outcomes. However, children and HIV-infected individuals appear to have a better out-come overall. … The medications of ‘notoriety’ for developing SJS/TEN as in the ALDEN scoring system are also responsible for a majority of the patients who develop DILI in the setting of SJS/TEN.”  – by Melinda Stevens

Disclosure: The researchers report no relevant financial disclosures.