Journal Scan / Research · December 30, 2020 Disseminated Intravascular Coagulopathy in SJS/TEN International Journal of Dermatology

TAKE-HOME MESSAGE

• Among 396 patients with Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) at the Mayo Clinic between July 2012 and January 2020, 5 (1.3%) developed disseminated intravascular coagulopathy (DIC). Of these, 4 patients died, and the fifth was lost to follow-up after a facility transfer.

• Although DIC is an uncommon complication of SJS/TEN, the associated increased mortality risk if patients do have concomitant DIC is substantial. Dermatologists should be aware of this association, and biopsy in SJS/TEN patients in which DIC is a concern should be considered emergent, as demonstration of microthrombi may be helpful in early DIC diagnosis and initiation of interventions such as anticoagulation, dialysis, or other supportive measures.

– Caroline K. Crabtree, MD

Abstract 

BACKGROUND

The purpose of this study was to retrospectively assess clinical characteristics and mortality rate of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in patients who developed disseminated intravascular coagulation (DIC).

METHODS

A systematic retrospective chart review of all patients with concurrent clinical diagnosis of DIC and SJS/TEN between July 1, 2012, and January 1, 2020, at the Mayo Clinic was performed.

RESULTS

The incidence of DIC in patients with SJS/TEN was 1.3% at our institution (5 of 396 DIC patients). Triggers of SJS/TEN included lamotrigine, clofarabine, antibiotics, and sepsis. Two patients diagnosed with SJS and two patients with TEN succumbed to the disease.

CONCLUSION

DIC is a rare underlying risk in patients with SJS/TEN and is associated with increased mortality. Early clinician awareness and aggressive intervention is advised.

International Journal of Dermatology

Disseminated Intravascular Coagulopathy: A Complication of Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis

Int. J. Dermatol 2020 Dec 17;[EPub Ahead of Print], RA El-Azhary, S Nowsheen, LE Gibson, DJ DiCaudo