일개 대학병원에서 수집한 스티븐스-존슨 증후군 및 독성표피괴사용해 70사례 분석
Experience of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in a Regional Hospital: 70 Cases in 7 Years
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목적: 스티븐스-존슨 증후군(SJS) 및 독성표피괴사용해(TEN)는 중증 피부약물이상반응이며, 치명적 결과를 유발할수 있다. 한 지역 기반의 대학병원에서 경험한 사례를 분석하였다. 대상 및 방법: 2008년부터 2014년까지 전문가에 의해 진단된 SJS/TEN 사례의 임상 양상, SCORTEN 등을 후향적으로 수집하였다. 결과: 7년간 SJS 56사례, TEN 14사례 등 총 70사례가 발생하였다. 40대에서 60대(남성 평균 55세, 여성 평균 54세)에흔하게 발생하였으며, 흔한 원인 약제는 항전간제(42.8%), 탄산탈수효소저해제(20.0%), 항균제(15.7%), 알로푸리놀(7.1%), 진통소염제(7.1%) 등이었다. 독성표피괴사용해 7사례(50%) 가 사망하였다. 사망 사례의 평균 연령은 67세였고, 남성(20%)보다 여성(67%)에서 흔하였다. 치명률은 SCORTEN으로 예측되었다. 생존 사례와 치료 방법에는 차이가 없었다. 결론: SJS/TEN의 원인약물 및 치명성에 대한 숙지가 필요하다. 고령 여성의 TEN에서 치명률이 높다. SCORTEN을 활용하여 치명률을 예측할 수 있다. 조기 발견 및 적절한 치료가 필수적이다.
Abstract
Background/Aims: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions that frequently result in fatal outcomes. We investigated cases of SJS and TEN in a regional hospital. Methods: From 2008 to 2014, SJS and TEN cases were enrolled retrospectively by allergy and dermatology specialists, and their clinical features and severity-of-illness score for TEN (SCORTEN) were assessed. Results: During the 7-year study period, 56 SJS and 14 TEN cases were recruited. The majority (71%) were 40-70 years of age (mean age of male and female patients, 55 and 54 years, respectively). Regarding drugs, anticonvulsants (42.8%) were the most frequently causative, followed by carbonic anhydrase inhibitors (20.0%), antimicrobials (15.7%), allopurinol (7.1%), and non-steroidal anti-inflammatory drugs (7.1%). No fatal case of SJS was seen. However, 7 of the 14 patients with TEN died (50%; mean age, 67 years; 1 of 5 [20%] males and 6 of 9 females [66.7%]). The mortality rate was reflected in the SCORTEN values. Vancomycin, allopurinol, methazolamide (two cases each) and megestrol (one case) were the causative drugs in the seven fatal TEN cases. Treatment modality did not affect the likelihood of death due to TEN. Conclusions: The causative drugs of, and frequency of mortality due to, SJS and TEN should be recognized by physicians. Elderly females with TEN are at high risk of mortality. SCORTEN values reflect the mortality rate of TEN patients. Early recognition and proper management of SJS and TEN may reduce the mortality rate.
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