Distinguishing Stevens-Johnson syndrome/toxic epidermal necrolysis from clinical mimickers during inpatient dermatologic consultation – a retrospective chart review

Abstract Background Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions that may present with similar findings to other severe dermatological diseases. Objective The primary objective of this exploratory study was to explore factors associated with SJS/TEN and develop a model that provides the predicted probability of SJS/TEN for patients where the diagnosis of SJS/TEN is considered. Methods Retrospective review of consultations for patients with suspected SJS, TEN or overlap at four academic dermatology consult services. Results Overall, 208 patients were included, 59 had a final diagnosis of SJS/TEN and 149 (71.6%) were given a different diagnosis. The most common mimickers were drug hypersensitivity syndrome (10.1%), morbilliform drug eruption (8.7%), erythema multiforme (7.2%), and acute generalized exanthematous pustulosis (6.2%). Nikolsky sign, atypical targets, fever and lymphopenia were included in a model for predicting the probability of SJS/TEN. Limitations All cases were obtained from academic centers which may limit the generalization of findings to community-based settings. Exploratory study with a small number of cases and need for external validation of the model performance. Conclusion Early dermatologic evaluation of patients with concern for SJS/TEN is key to separate patients with this condition from those ultimately diagnosed with other serious skin diseases.