Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature
Identifieur interne : 000740 ( Istex/Corpus ); précédent : 000739; suivant : 000741Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature
Auteurs : M. Ziemer ; S. H. Kardaun ; Y. Liss ; M. MockenhauptSource :
- British Journal of Dermatology [ 0007-0963 ] ; 2012-03.
Abstract
Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality. Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of sheet‐like epidermal necrosis. Objective To evaluate clinically and histopathologically probable or definite cases of SJS/TEN with a history of systemic or other LE [(S)LE]. Methods This was a retrospective analysis of validated cases of SJS/TEN with a history of (S)LE, based on a large population‐based national registry. Results Among 1366 patients with SJS/TEN, 17 with a sufficiently documented history of (S)LE and representative histological material could be identified, suggesting a considerable over‐representation of LE in patients with SJS/TEN. Eight of these showed clinically and/or histopathologically some LE‐characteristic features interfering with the diagnosis of SJS/TEN. Differentiation could be elaborated on clinical and histopathological grounds: four patients were classified as SJS/TEN with a preceding (S)LE exacerbation and/or LE‐typical histopathological features, and four as ‘TEN‐like’ (S)LE. Conclusion Most patients with SJS/TEN and a history of (S)LE demonstrate clinical and histopathological properties allowing clear differentiation. However, occasionally acute cutaneous manifestations of (S)LE and SJS/TEN can be phenotypically similar, caused by extensive epidermal necrosis. Although no feature by itself is conclusive, a combination of recent (S)LE exacerbation, evident photodistribution, annular lesions and absent or only mild focal erosive mucosal involvement may favour LE over SJS/TEN clinically. Histopathologically, in particular, junctional vacuolar alteration, and the presence of solitary necrotic keratinocytes at lower epidermal levels, combined with moderate to dense periadnexal and perivascular lymphocytic infiltrates with a variable presence of melanophages, and mucin point to a LE‐related origin.
Url:
DOI: 10.1111/j.1365-2133.2011.10705.x
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<record><TEI wicri:istexFullTextTei="biblStruct"><teiHeader><fileDesc><titleStmt><title xml:lang="en">Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title><author><name sortKey="Ziemer, M" sort="Ziemer, M" uniqKey="Ziemer M" first="M." last="Ziemer">M. Ziemer</name><affiliation><mods:affiliation>Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp‐Rosenthal‐Str. 23–25, 04103 Leipzig, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kardaun, S H" sort="Kardaun, S H" uniqKey="Kardaun S" first="S. H." last="Kardaun">S. H. Kardaun</name><affiliation><mods:affiliation>Department of Dermatology, Reference Centre for Cutaneous Adverse Reactions, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Liss, Y" sort="Liss, Y" uniqKey="Liss Y" first="Y." last="Liss">Y. Liss</name><affiliation><mods:affiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Mockenhaupt, M" sort="Mockenhaupt, M" uniqKey="Mockenhaupt M" first="M." last="Mockenhaupt">M. Mockenhaupt</name><affiliation><mods:affiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</mods:affiliation></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">ISTEX</idno><idno type="RBID">ISTEX:98E5A48BF65BECD8A5FFD320FBEF8F0164D824DE</idno><date when="2012" year="2012">2012</date><idno type="doi">10.1111/j.1365-2133.2011.10705.x</idno><idno type="url">https://api.istex.fr/ark:/67375/WNG-GD7GPLTN-K/fulltext.pdf</idno><idno type="wicri:Area/Istex/Corpus">000740</idno><idno type="wicri:explorRef" wicri:stream="Istex" wicri:step="Corpus" wicri:corpus="ISTEX">000740</idno></publicationStmt><sourceDesc><biblStruct><analytic><title level="a" type="main">Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title><author><name sortKey="Ziemer, M" sort="Ziemer, M" uniqKey="Ziemer M" first="M." last="Ziemer">M. Ziemer</name><affiliation><mods:affiliation>Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp‐Rosenthal‐Str. 23–25, 04103 Leipzig, Germany</mods:affiliation></affiliation></author><author><name sortKey="Kardaun, S H" sort="Kardaun, S H" uniqKey="Kardaun S" first="S. H." last="Kardaun">S. H. Kardaun</name><affiliation><mods:affiliation>Department of Dermatology, Reference Centre for Cutaneous Adverse Reactions, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands</mods:affiliation></affiliation></author><author><name sortKey="Liss, Y" sort="Liss, Y" uniqKey="Liss Y" first="Y." last="Liss">Y. Liss</name><affiliation><mods:affiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</mods:affiliation></affiliation></author><author><name sortKey="Mockenhaupt, M" sort="Mockenhaupt, M" uniqKey="Mockenhaupt M" first="M." last="Mockenhaupt">M. Mockenhaupt</name><affiliation><mods:affiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j" type="main">British Journal of Dermatology</title><title level="j" type="alt">BRITISH JOURNAL OF DERMATOLOGY</title><idno type="ISSN">0007-0963</idno><idno type="eISSN">1365-2133</idno><imprint><biblScope unit="vol">166</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="575">575</biblScope><biblScope unit="page" to="600">600</biblScope><biblScope unit="page-count">26</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2012-03">2012-03</date></imprint><idno type="ISSN">0007-0963</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0007-0963</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality. Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of sheet‐like epidermal necrosis. Objective To evaluate clinically and histopathologically probable or definite cases of SJS/TEN with a history of systemic or other LE [(S)LE]. Methods This was a retrospective analysis of validated cases of SJS/TEN with a history of (S)LE, based on a large population‐based national registry. Results Among 1366 patients with SJS/TEN, 17 with a sufficiently documented history of (S)LE and representative histological material could be identified, suggesting a considerable over‐representation of LE in patients with SJS/TEN. Eight of these showed clinically and/or histopathologically some LE‐characteristic features interfering with the diagnosis of SJS/TEN. Differentiation could be elaborated on clinical and histopathological grounds: four patients were classified as SJS/TEN with a preceding (S)LE exacerbation and/or LE‐typical histopathological features, and four as ‘TEN‐like’ (S)LE. Conclusion Most patients with SJS/TEN and a history of (S)LE demonstrate clinical and histopathological properties allowing clear differentiation. However, occasionally acute cutaneous manifestations of (S)LE and SJS/TEN can be phenotypically similar, caused by extensive epidermal necrosis. Although no feature by itself is conclusive, a combination of recent (S)LE exacerbation, evident photodistribution, annular lesions and absent or only mild focal erosive mucosal involvement may favour LE over SJS/TEN clinically. Histopathologically, in particular, junctional vacuolar alteration, and the presence of solitary necrotic keratinocytes at lower epidermal levels, combined with moderate to dense periadnexal and perivascular lymphocytic infiltrates with a variable presence of melanophages, and mucin point to a LE‐related origin.</div></front></TEI><istex><corpusName>wiley</corpusName><keywords><teeft><json:string>lupus</json:string><json:string>erythematosus</json:string><json:string>epidermal</json:string><json:string>lupus erythematosus</json:string><json:string>cutaneous</json:string><json:string>histopathological</json:string><json:string>necrolysis</json:string><json:string>keratinocytes</json:string><json:string>toxic epidermal necrolysis</json:string><json:string>ziemer</json:string><json:string>british association</json:string><json:string>dermatologist</json:string><json:string>erythema</json:string><json:string>dermatol</json:string><json:string>mucous</json:string><json:string>dermatology</json:string><json:string>lymphocytic</json:string><json:string>immunosuppressive</json:string><json:string>vacuolar</json:string><json:string>lesion</json:string><json:string>infiltrates</json:string><json:string>systemic lupus erythematosus</json:string><json:string>erosive</json:string><json:string>scle</json:string><json:string>necrotic</json:string><json:string>bullous</json:string><json:string>skin lesion</json:string><json:string>subepidermal</json:string><json:string>erythematous</json:string><json:string>prednisolone</json:string><json:string>photodistribution</json:string><json:string>mockenhaupt</json:string><json:string>perivascular</json:string><json:string>mucosal</json:string><json:string>syndrome</json:string><json:string>datum</json:string><json:string>histological</json:string><json:string>corticosteroid</json:string><json:string>anaemia</json:string><json:string>solitary necrotic keratinocytes</json:string><json:string>multiforme</json:string><json:string>bulla</json:string><json:string>leucopenia</json:string><json:string>clin</json:string><json:string>eventa</json:string><json:string>nephritis</json:string><json:string>melanophages</json:string><json:string>mucin</json:string><json:string>acle</json:string><json:string>periodb</json:string><json:string>subacute</json:string><json:string>periadnexal</json:string><json:string>annular</json:string><json:string>previous change</json:string><json:string>histopathological feature</json:string><json:string>necrotic keratinocytes</json:string><json:string>toxic</json:string><json:string>rash</json:string><json:string>german registry</json:string><json:string>severe cutaneous adverse reaction</json:string><json:string>bullous lesion</json:string><json:string>antinuclear antibody</json:string><json:string>immunosuppressive therapy</json:string><json:string>acad dermatol</json:string><json:string>diagnosis event</json:string><json:string>vacuolar alteration</json:string><json:string>dermoepidermal junction</json:string><json:string>cutaneous lupus erythematosus</json:string><json:string>atypical</json:string><json:string>systemic</json:string><json:string>inflammatory</json:string><json:string>clinical characteristic</json:string><json:string>periadnexal lymphocytic infiltrates</json:string><json:string>arch dermatol</json:string><json:string>characteristic laboratory value immunosuppressive therapy</json:string><json:string>female patient</json:string><json:string>erythema multiforme</json:string><json:string>sol lip</json:string><json:string>epidermis</json:string><json:string>medication</json:string><json:string>histology</json:string><json:string>degeneration</json:string><json:string>vacuolar degeneration</json:string><json:string>other risk factor</json:string><json:string>characteristic laboratory value</json:string><json:string>basement membrane zone</json:string><json:string>lower epidermal level</json:string><json:string>annular lesion</json:string><json:string>basal cell</json:string><json:string>direct immunofluorescence</json:string><json:string>rheumatoid factor</json:string><json:string>lower epidermis</json:string><json:string>eosin original magnification</json:string><json:string>university hospital</json:string><json:string>second episode</json:string><json:string>concomitant histological feature</json:string><json:string>atypical target flat</json:string><json:string>large area</json:string><json:string>plasma cell</json:string><json:string>development mucous membrane involvement histology</json:string><json:string>risk factor</json:string><json:string>body surface area</json:string><json:string>evident photodistribution</json:string><json:string>necrosis</json:string><json:string>sol</json:string><json:string>exacerbation</json:string><json:string>culprit</json:string><json:string>membrane</json:string></teeft></keywords><author><json:item><name>M. Ziemer</name><affiliations><json:string>Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp‐Rosenthal‐Str. 23–25, 04103 Leipzig, Germany</json:string></affiliations></json:item><json:item><name>S.H. Kardaun</name><affiliations><json:string>Department of Dermatology, Reference Centre for Cutaneous Adverse Reactions, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands</json:string></affiliations></json:item><json:item><name>Y. Liss</name><affiliations><json:string>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</json:string></affiliations></json:item><json:item><name>M. Mockenhaupt</name><affiliations><json:string>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</json:string></affiliations></json:item></author><articleId><json:string>BJD10705</json:string></articleId><arkIstex>ark:/67375/WNG-GD7GPLTN-K</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>article</json:string></originalGenre><abstract>Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality. Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of sheet‐like epidermal necrosis. Objective To evaluate clinically and histopathologically probable or definite cases of SJS/TEN with a history of systemic or other LE [(S)LE]. Methods This was a retrospective analysis of validated cases of SJS/TEN with a history of (S)LE, based on a large population‐based national registry. Results Among 1366 patients with SJS/TEN, 17 with a sufficiently documented history of (S)LE and representative histological material could be identified, suggesting a considerable over‐representation of LE in patients with SJS/TEN. Eight of these showed clinically and/or histopathologically some LE‐characteristic features interfering with the diagnosis of SJS/TEN. Differentiation could be elaborated on clinical and histopathological grounds: four patients were classified as SJS/TEN with a preceding (S)LE exacerbation and/or LE‐typical histopathological features, and four as ‘TEN‐like’ (S)LE. Conclusion Most patients with SJS/TEN and a history of (S)LE demonstrate clinical and histopathological properties allowing clear differentiation. However, occasionally acute cutaneous manifestations of (S)LE and SJS/TEN can be phenotypically similar, caused by extensive epidermal necrosis. Although no feature by itself is conclusive, a combination of recent (S)LE exacerbation, evident photodistribution, annular lesions and absent or only mild focal erosive mucosal involvement may favour LE over SJS/TEN clinically. Histopathologically, in particular, junctional vacuolar alteration, and the presence of solitary necrotic keratinocytes at lower epidermal levels, combined with moderate to dense periadnexal and perivascular lymphocytic infiltrates with a variable presence of melanophages, and mucin point to a LE‐related origin.</abstract><qualityIndicators><refBibsNative>true</refBibsNative><abstractWordCount>272</abstractWordCount><abstractCharCount>2060</abstractCharCount><keywordCount>0</keywordCount><score>10</score><pdfWordCount>8164</pdfWordCount><pdfCharCount>64861</pdfCharCount><pdfVersion>1.3</pdfVersion><pdfPageCount>26</pdfPageCount><pdfPageSize>595.276 x 782.362 pts</pdfPageSize><pdfWordsPerPage>314</pdfWordsPerPage><pdfText>true</pdfText></qualityIndicators><title>Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title><pmid><json:string>22014091</json:string></pmid><genre><json:string>article</json:string></genre><host><title>British Journal of Dermatology</title><language><json:string>unknown</json:string></language><doi><json:string>10.1111/(ISSN)1365-2133</json:string></doi><issn><json:string>0007-0963</json:string></issn><eissn><json:string>1365-2133</json:string></eissn><publisherId><json:string>BJD</json:string></publisherId><volume>166</volume><issue>3</issue><pages><first>575</first><last>600</last><total>26</total></pages><genre><json:string>journal</json:string></genre><subject><json:item><value>Original articles</value></json:item><json:item><value>Epidemiology and health services research</value></json:item><json:item><value>EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH</value></json:item></subject></host><namedEntities><unitex><date><json:string>1362</json:string><json:string>2590</json:string><json:string>2012</json:string><json:string>2003</json:string></date><geogName></geogName><orgName><json:string>Department of Der</json:string><json:string>Department of Dermatology, University Hospital Regensburg</json:string><json:string>Department of Dermatology, University Hospital Halle</json:string><json:string>Medical Center</json:string><json:string>Else Kroner-Fresenius-Foundation</json:string><json:string>Medical Center, Freiburg</json:string><json:string>University Hospital Tubingen</json:string><json:string>Department of Dermatology, University Medical Center, Mainz</json:string><json:string>Department of Dermatology, Fachklinik</json:string><json:string>Department of Pathology, University of Bonn</json:string><json:string>Germany Summary Correspondence Sylvia H</json:string><json:string>Netherlands Dokumentationszentrum</json:string><json:string>Research and Technology</json:string><json:string>University Hospital Erlangen-Nu</json:string><json:string>Department of Dermatology, University Hospital Aachen</json:string><json:string>European Commission</json:string><json:string>Federal Institute for Drugs</json:string><json:string>University Hospital Wurzburg</json:string><json:string>Department of Dermatology, Reference Centre for Cutaneous Adverse Reactions, University Medical Centre Groningen, University of Groningen, Hanzeplein</json:string><json:string>Department of Internal Medicine, University Freiburg</json:string><json:string>University Hospital Leipzig, Philipp-Rosenthal-Str</json:string><json:string>ACR</json:string><json:string>Department of Dermatology, Freie Uni</json:string><json:string>Department of Dermatology, University Hospital Jena</json:string><json:string>Department of Dermatology, St Barbara Hospital, Duisburg</json:string><json:string>Department of Dermatology, St Marienhospital, Vechta</json:string><json:string>Cephalon Inc.</json:string><json:string>Department of Dermatol</json:string><json:string>American College of Rheumatology</json:string><json:string>Department of Dermatology, University Freiburg</json:string><json:string>Department of Dermatology, Klinikum Krefeld</json:string></orgName><orgName_funder></orgName_funder><orgName_provider></orgName_provider><persName><json:string>Willmar Schwabe</json:string><json:string>S.H. 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Ziemer et al.</json:string><json:string>Rowell et al.</json:string><json:string>Bastuji-Garin et al.</json:string><json:string>November 2009</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/WNG-GD7GPLTN-K</json:string></ark><categories><wos><json:string>1 - science</json:string><json:string>2 - dermatology</json:string></wos><scienceMetrix><json:string>1 - health sciences</json:string><json:string>2 - clinical medicine</json:string><json:string>3 - dermatology & venereal diseases</json:string></scienceMetrix><scopus><json:string>1 - Health Sciences</json:string><json:string>2 - Medicine</json:string><json:string>3 - Dermatology</json:string></scopus><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string></inist></categories><publicationDate>2012</publicationDate><copyrightDate>2012</copyrightDate><doi><json:string>10.1111/j.1365-2133.2011.10705.x</json:string></doi><id>98E5A48BF65BECD8A5FFD320FBEF8F0164D824DE</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-GD7GPLTN-K/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-GD7GPLTN-K/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/WNG-GD7GPLTN-K/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a" type="main">Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title><title level="a" type="short">SJS and TEN with lupus erythematosus</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><availability><licence>© 2011 The Authors. BJD © 2011 British Association of Dermatologists</licence></availability><date type="published" when="2012-03"></date></publicationStmt><notesStmt><note type="content-type" subtype="article" source="article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</note><note type="publication-type" subtype="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note></notesStmt><sourceDesc><biblStruct type="article"><analytic><title level="a" type="main">Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title><title level="a" type="short">SJS and TEN with lupus erythematosus</title><author xml:id="author-0000"><persName><forename type="first">M.</forename><surname>Ziemer</surname></persName><affiliation><orgName type="department">Department of Dermatology</orgName><orgName type="department">Venereology and Allergology</orgName><orgName type="institution">University Hospital Leipzig</orgName><address><addrLine>Philipp‐Rosenthal‐Str. 23–25</addrLine><addrLine>04103 Leipzig, Germany</addrLine><country key="DE" xml:lang="en">GERMANY</country></address></affiliation></author><author xml:id="author-0001"><persName><forename type="first">S.H.</forename><surname>Kardaun</surname></persName><affiliation><orgName type="department">Department of Dermatology</orgName><orgName type="division">Reference Centre for Cutaneous Adverse Reactions</orgName><orgName type="institution">University Medical Centre Groningen</orgName><orgName type="institution">University of Groningen</orgName><address><addrLine>Hanzeplein 1</addrLine><addrLine>9713 GZ Groningen, the Netherlands</addrLine><country key="NL" xml:lang="en">THE NETHERLANDS</country></address></affiliation></author><author xml:id="author-0002"><persName><forename type="first">Y.</forename><surname>Liss</surname></persName><affiliation><address><addrLine>Dokumentationszentrum schwerer Hautreaktionen (dZh)</addrLine><addrLine>Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</addrLine><country key="DE" xml:lang="en">GERMANY</country></address></affiliation></author><author xml:id="author-0003"><persName><forename type="first">M.</forename><surname>Mockenhaupt</surname></persName><affiliation><address><addrLine>Dokumentationszentrum schwerer Hautreaktionen (dZh)</addrLine><addrLine>Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</addrLine><country key="DE" xml:lang="en">GERMANY</country></address></affiliation></author><idno type="istex">98E5A48BF65BECD8A5FFD320FBEF8F0164D824DE</idno><idno type="ark">ark:/67375/WNG-GD7GPLTN-K</idno><idno type="DOI">10.1111/j.1365-2133.2011.10705.x</idno><idno type="unit">BJD10705</idno><idno type="toTypesetVersion">file:BJD.BJD10705.pdf</idno></analytic><monogr><title level="j" type="main">British Journal of Dermatology</title><title level="j" type="alt">BRITISH JOURNAL OF DERMATOLOGY</title><idno type="pISSN">0007-0963</idno><idno type="eISSN">1365-2133</idno><idno type="book-DOI">10.1111/(ISSN)1365-2133</idno><idno type="book-part-DOI">10.1111/bjd.2012.166.issue-3</idno><idno type="product">BJD</idno><idno type="publisherDivision">ST</idno><imprint><biblScope unit="vol">166</biblScope><biblScope unit="issue">3</biblScope><biblScope unit="page" from="575">575</biblScope><biblScope unit="page" to="600">600</biblScope><biblScope unit="page-count">26</biblScope><publisher>Blackwell Publishing Ltd</publisher><pubPlace>Oxford, UK</pubPlace><date type="published" when="2012-03"></date></imprint></monogr></biblStruct></sourceDesc></fileDesc><encodingDesc><schemaRef type="ODD" url="https://xml-schema.delivery.istex.fr/tei-istex.odd"></schemaRef><appInfo><application ident="pub2tei" version="1.0.10" when="2019-12-20"><label>pub2TEI-ISTEX</label><desc>A set of style sheets for converting XML documents encoded in various scientific publisher formats into a common TEI format.
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Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of sheet‐like epidermal necrosis.</p><p><hi rend="bold">Objective </hi> To evaluate clinically and histopathologically probable or definite cases of SJS/TEN with a history of systemic or other LE [(S)LE].</p><p><hi rend="bold">Methods </hi> This was a retrospective analysis of validated cases of SJS/TEN with a history of (S)LE, based on a large population‐based national registry.</p><p><hi rend="bold">Results </hi> Among 1366 patients with SJS/TEN, 17 with a sufficiently documented history of (S)LE and representative histological material could be identified, suggesting a considerable over‐representation of LE in patients with SJS/TEN. Eight of these showed clinically and/or histopathologically some LE‐characteristic features interfering with the diagnosis of SJS/TEN. Differentiation could be elaborated on clinical and histopathological grounds: four patients were classified as SJS/TEN with a preceding (S)LE exacerbation and/or LE‐typical histopathological features, and four as ‘TEN‐like’ (S)LE.</p><p><hi rend="bold">Conclusion </hi> Most patients with SJS/TEN and a history of (S)LE demonstrate clinical and histopathological properties allowing clear differentiation. However, occasionally acute cutaneous manifestations of (S)LE and SJS/TEN can be phenotypically similar, caused by extensive epidermal necrosis. Although no feature by itself is conclusive, a combination of recent (S)LE exacerbation, evident photodistribution, annular lesions and absent or only mild focal erosive mucosal involvement may favour LE over SJS/TEN clinically. Histopathologically, in particular, junctional vacuolar alteration, and the presence of solitary necrotic keratinocytes at lower epidermal levels, combined with moderate to dense periadnexal and perivascular lymphocytic infiltrates with a variable presence of melanophages, and mucin point to a LE‐related origin.</p></abstract><textClass><keywords rend="tocHeading1"><term>Original articles</term></keywords><keywords rend="tocHeading2"><term>Epidemiology and health services research</term></keywords><keywords rend="articleCategory"><term>EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH</term></keywords></textClass><langUsage><language ident="en"></language></langUsage></profileDesc><revisionDesc><change when="2019-12-20" who="#istex" xml:id="pub2tei">formatting</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/WNG-GD7GPLTN-K/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Wiley, elements deleted: body"><istex:xmlDeclaration>version="1.0" encoding="UTF-8" standalone="yes"</istex:xmlDeclaration><istex:document><component version="2.0" type="serialArticle" xml:lang="en"><header><publicationMeta level="product"><publisherInfo><publisherName>Blackwell Publishing Ltd</publisherName><publisherLoc>Oxford, UK</publisherLoc></publisherInfo><doi origin="wiley" registered="yes">10.1111/(ISSN)1365-2133</doi><issn type="print">0007-0963</issn><issn type="electronic">1365-2133</issn><idGroup><id type="product" value="BJD"></id><id type="publisherDivision" value="ST"></id></idGroup><titleGroup><title type="main" sort="BRITISH JOURNAL OF DERMATOLOGY">British Journal of Dermatology</title></titleGroup></publicationMeta><publicationMeta level="part" position="03103"><doi origin="wiley">10.1111/bjd.2012.166.issue-3</doi><numberingGroup><numbering type="journalVolume" number="166">166</numbering><numbering type="journalIssue" number="3">3</numbering></numberingGroup><coverDate startDate="2012-03">March 2012</coverDate></publicationMeta><publicationMeta level="unit" type="article" position="18" status="forIssue"><doi origin="wiley">10.1111/j.1365-2133.2011.10705.x</doi><idGroup><id type="unit" value="BJD10705"></id></idGroup><countGroup><count type="pageTotal" number="26"></count></countGroup><titleGroup><title type="tocHeading1">Original articles</title><title type="tocHeading2">Epidemiology and health services research</title><title type="articleCategory">EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH</title></titleGroup><copyright>© 2011 The Authors. BJD © 2011 British Association of Dermatologists</copyright><eventGroup><event type="xmlConverted" agent="Converter:BPG_TO_WML3G version:3.1.3 standalone mode:FullText" date="2012-02-22"></event><event type="publishedOnlineAccepted" date="2011-10-20"></event><event type="firstOnline" date="2012-02-22"></event><event type="publishedOnlineFinalForm" date="2012-02-22"></event><event type="xmlConverted" agent="Converter:WILEY_ML3G_TO_WILEY_ML3GV2 version:4.0.1" date="2014-03-15"></event><event type="xmlConverted" agent="Converter:WML3G_To_WML3G version:4.3.4 mode:FullText" date="2015-02-25"></event></eventGroup><numberingGroup><numbering type="pageFirst" number="575">575</numbering><numbering type="pageLast" number="600">600</numbering></numberingGroup><correspondenceTo>Sylvia H. Kardaun or Mirjana Ziemer.
E‐mail: <email>s.h.kardaun@derm.umcg.nl</email>; <email normalForm="mirjana.ziemer@medizin.uni-leipzig.de">mirjana.ziemer@medizin.uni‐leipzig.de</email></correspondenceTo><linkGroup><link type="toTypesetVersion" href="file:BJD.BJD10705.pdf"></link></linkGroup></publicationMeta><contentMeta><unparsedEditorialHistory>Accepted for publication 13 October 2011</unparsedEditorialHistory><countGroup><count type="figureTotal" number="3"></count><count type="tableTotal" number="5"></count></countGroup><titleGroup><title type="main">Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title><title type="shortAuthors">M. Ziemer <i>et al.</i></title><title type="short">SJS and TEN with lupus erythematosus</title></titleGroup><creators><creator creatorRole="author" xml:id="cr1" affiliationRef="#a1"><personName><givenNames>M.</givenNames><familyName>Ziemer</familyName></personName></creator><creator creatorRole="author" xml:id="cr2" affiliationRef="#a2"><personName><givenNames>S.H.</givenNames><familyName>Kardaun</familyName></personName></creator><creator creatorRole="author" xml:id="cr3" affiliationRef="#a3"><personName><givenNames>Y.</givenNames><familyName>Liss</familyName></personName></creator><creator creatorRole="author" xml:id="cr4" affiliationRef="#a3"><personName><givenNames>M.</givenNames><familyName>Mockenhaupt</familyName></personName></creator></creators><affiliationGroup><affiliation xml:id="a1" countryCode="DE"><unparsedAffiliation>Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp‐Rosenthal‐Str. 23–25, 04103 Leipzig, Germany</unparsedAffiliation></affiliation><affiliation xml:id="a2" countryCode="NL"><unparsedAffiliation>Department of Dermatology, Reference Centre for Cutaneous Adverse Reactions, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands</unparsedAffiliation></affiliation><affiliation xml:id="a3" countryCode="DE"><unparsedAffiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</unparsedAffiliation></affiliation></affiliationGroup><abstractGroup><abstract type="main" xml:lang="en"><title type="main">Summary</title><p><b>Background </b> Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality. Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of sheet‐like epidermal necrosis.</p><p><b>Objective </b> To evaluate clinically and histopathologically probable or definite cases of SJS/TEN with a history of systemic or other LE [(S)LE].</p><p><b>Methods </b> This was a retrospective analysis of validated cases of SJS/TEN with a history of (S)LE, based on a large population‐based national registry.</p><p><b>Results </b> Among 1366 patients with SJS/TEN, 17 with a sufficiently documented history of (S)LE and representative histological material could be identified, suggesting a considerable over‐representation of LE in patients with SJS/TEN. Eight of these showed clinically and/or histopathologically some LE‐characteristic features interfering with the diagnosis of SJS/TEN. Differentiation could be elaborated on clinical and histopathological grounds: four patients were classified as SJS/TEN with a preceding (S)LE exacerbation and/or LE‐typical histopathological features, and four as ‘TEN‐like’ (S)LE.</p><p><b>Conclusion </b> Most patients with SJS/TEN and a history of (S)LE demonstrate clinical and histopathological properties allowing clear differentiation. However, occasionally acute cutaneous manifestations of (S)LE and SJS/TEN can be phenotypically similar, caused by extensive epidermal necrosis. Although no feature by itself is conclusive, a combination of recent (S)LE exacerbation, evident photodistribution, annular lesions and absent or only mild focal erosive mucosal involvement may favour LE over SJS/TEN clinically. Histopathologically, in particular, junctional vacuolar alteration, and the presence of solitary necrotic keratinocytes at lower epidermal levels, combined with moderate to dense periadnexal and perivascular lymphocytic infiltrates with a variable presence of melanophages, and mucin point to a LE‐related origin.</p></abstract></abstractGroup></contentMeta><noteGroup><note xml:id="fn1"><p>Funding sources
M.Z. and S.H.K., none; Y.L. and M.M., the German Registry was funded by the following institutions: Ministry for Research and Technology (Bundesministerium für Forschung und Technologie; BMFT), grant no. 0701 564/4 (1990–1995); Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte; BfArM), grant no. GS 1‐68502‐200 (1995–1998) and grant no. Z121.01‐68502‐208 (2001–2002); European Commission, RegiSCAR‐project in the 5th Framework, grant no. QLRT‐2002‐01738 (2002–2005); and a consortium of pharmaceutical companies (Ciba Geigy/Novartis; Hoffmann‐La‐Roche; Hoechst AG/Hoechst Marion Roussel/Aventis; Sanofi Winthrop/Sanofi Synthelabo; Bayer AG/Bayer Vital; Glaxo Wellcome/GlaxoSmithKline; Schering AG; Goedecke Parke Davis; Pfizer GmbH; Cilag GmbH; Dr Willmar Schwabe; Boehringer Ingelheim; MSD Sharp & Dohme; Merck U.S.A.; Cephalon Inc.; Tibotec B.V.). M.M. received the Else Kröner Memorial Stipendium for support of clinical research through Else Kröner‐Fresenius‐Foundation (2008–2009).</p></note><note xml:id="fn2"><p>Conflicts of interest
None declared.</p></note><note xml:id="fn3"><p>M.Z. and S.H.K. contributed equally to this study.</p></note></noteGroup></header></component></istex:document></istex:metadataXml><mods version="3.6"><titleInfo lang="en"><title>Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title></titleInfo><titleInfo type="abbreviated" lang="en"><title>SJS and TEN with lupus erythematosus</title></titleInfo><titleInfo type="alternative" contentType="CDATA" lang="en"><title>Stevens–Johnson syndrome and toxic epidermal necrolysis in patients with lupus erythematosus: a descriptive study of 17 cases from a national registry and review of the literature</title></titleInfo><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Ziemer</namePart><affiliation>Department of Dermatology, Venereology and Allergology, University Hospital Leipzig, Philipp‐Rosenthal‐Str. 23–25, 04103 Leipzig, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">S.H.</namePart><namePart type="family">Kardaun</namePart><affiliation>Department of Dermatology, Reference Centre for Cutaneous Adverse Reactions, University Medical Centre Groningen, University of Groningen, Hanzeplein 1, 9713 GZ Groningen, the Netherlands</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">Y.</namePart><namePart type="family">Liss</namePart><affiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">M.</namePart><namePart type="family">Mockenhaupt</namePart><affiliation>Dokumentationszentrum schwerer Hautreaktionen (dZh), Department of Dermatology, University Freiburg – Medical Center, Freiburg, Germany</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="article" displayLabel="article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-6N5SZHKN-D">article</genre><originInfo><publisher>Blackwell Publishing Ltd</publisher><place><placeTerm type="text">Oxford, UK</placeTerm></place><dateIssued encoding="w3cdtf">2012-03</dateIssued><edition>Accepted for publication 13 October 2011</edition><copyrightDate encoding="w3cdtf">2012</copyrightDate></originInfo><language><languageTerm type="code" authority="rfc3066">en</languageTerm><languageTerm type="code" authority="iso639-2b">eng</languageTerm></language><physicalDescription><extent unit="figures">3</extent><extent unit="tables">5</extent></physicalDescription><abstract lang="en">Background Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe cutaneous adverse reactions with high morbidity and mortality. Some expressions of lupus erythematosus (LE) may cause enormous difficulties in differentiating them from SJS and TEN by showing large areas of sheet‐like epidermal necrosis. Objective To evaluate clinically and histopathologically probable or definite cases of SJS/TEN with a history of systemic or other LE [(S)LE]. Methods This was a retrospective analysis of validated cases of SJS/TEN with a history of (S)LE, based on a large population‐based national registry. Results Among 1366 patients with SJS/TEN, 17 with a sufficiently documented history of (S)LE and representative histological material could be identified, suggesting a considerable over‐representation of LE in patients with SJS/TEN. Eight of these showed clinically and/or histopathologically some LE‐characteristic features interfering with the diagnosis of SJS/TEN. Differentiation could be elaborated on clinical and histopathological grounds: four patients were classified as SJS/TEN with a preceding (S)LE exacerbation and/or LE‐typical histopathological features, and four as ‘TEN‐like’ (S)LE. Conclusion Most patients with SJS/TEN and a history of (S)LE demonstrate clinical and histopathological properties allowing clear differentiation. However, occasionally acute cutaneous manifestations of (S)LE and SJS/TEN can be phenotypically similar, caused by extensive epidermal necrosis. Although no feature by itself is conclusive, a combination of recent (S)LE exacerbation, evident photodistribution, annular lesions and absent or only mild focal erosive mucosal involvement may favour LE over SJS/TEN clinically. Histopathologically, in particular, junctional vacuolar alteration, and the presence of solitary necrotic keratinocytes at lower epidermal levels, combined with moderate to dense periadnexal and perivascular lymphocytic infiltrates with a variable presence of melanophages, and mucin point to a LE‐related origin.</abstract><relatedItem type="host"><titleInfo><title>British Journal of Dermatology</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><subject><genre>article-category</genre><topic>Original articles</topic><topic>Epidemiology and health services research</topic><topic>EPIDEMIOLOGY AND HEALTH SERVICES RESEARCH</topic></subject><identifier type="ISSN">0007-0963</identifier><identifier type="eISSN">1365-2133</identifier><identifier type="DOI">10.1111/(ISSN)1365-2133</identifier><identifier type="PublisherID">BJD</identifier><part><date>2012</date><detail type="volume"><caption>vol.</caption><number>166</number></detail><detail type="issue"><caption>no.</caption><number>3</number></detail><extent unit="pages"><start>575</start><end>600</end><total>26</total></extent></part></relatedItem><relatedItem type="references" displayLabel="cit1"><titleInfo><title>Clinical classification of cases of toxic epidermal necrolysis, Stevens–Johnson syndrome, and erythema multiforme</title></titleInfo><name type="personal"><namePart type="given">S</namePart><namePart type="family">Bastuji‐Garin</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">B</namePart><namePart type="family">Rzany</namePart><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">RS</namePart><namePart type="family">Stern</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal-article</genre><note type="citation/reference">Bastuji‐Garin S, Rzany B, Stern RS et al. 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Arch Dermatol 1993; 129:92–6.</note><part><date>1993</date><detail type="volume"><caption>vol.</caption><number>129</number></detail><extent unit="pages"><start>92</start><end>6</end></extent></part><relatedItem type="host"><titleInfo><title>Arch Dermatol</title></titleInfo><part><date>1993</date><detail type="volume"><caption>vol.</caption><number>129</number></detail><extent unit="pages"><start>92</start><end>6</end></extent></part></relatedItem></relatedItem><relatedItem type="references" displayLabel="cit2"><titleInfo><title>Severe cutaneous adverse reactions</title></titleInfo><name type="personal"><namePart type="given">M</namePart><namePart type="family">Mockenhaupt</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>book-chapter</genre><relatedItem type="host"><titleInfo><title>Braun‐Falco’s Dermatology</title></titleInfo><originInfo><publisher>Springer Medizin Verlag</publisher></originInfo><part><date>2009</date><extent unit="pages"><start>473</start><end>84</end></extent></part></relatedItem></relatedItem><relatedItem type="references" displayLabel="cit3"><titleInfo><title>The current understanding of Stevens–Johnson syndrome and toxic epidermal necrolysis</title></titleInfo><name type="personal"><namePart type="given">M</namePart><namePart type="family">Mockenhaupt</namePart><role><roleTerm type="text">author</roleTerm></role></name><genre>journal-article</genre><note type="citation/reference">Mockenhaupt M. 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