Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) most commonly includes liver and skin. However, drug reactions can rarely influence both organs concomitantly. Further studies are required to determine clinical features, risk factors, and prognostic markers of drug-induced liver injury (DILI) in patients with SJS/TEN. 

The present review assessed the clinical features, risk factors, and prognostic markers of DILI in patients with SJS/TEN hospitalized at the dermatology department of our hospital from January 2009 to December 2018.

The study included 298 patients with SJS/TEN, among them 40 had liver injury and the remaining were used as control. Causative drugs incorporated were antipodagrics (xanthine oxidase inhibitors occupying 100% among antipodagrics), anticonvulsants (dibenzazepine occupying 76.92% among anticonvulsants), and traditional Chinese medicines. Evidence of substantial difference was found between the patients with liver injury and the control group in regard to history of liver disease, diabetes, and hyperlipidemia. A total of nine of the 40 patients died with liver injury. Moreover, a significant association was revealed between high serum total bilirubin and creatinine levels and poor prognosis of DILI in patients with SJS/TEN.

Thus, the trial concluded that DILI is a common finding in patients with SJS/TEN. The important risk factors for DILI in patients with SJS/TEN include pre-existing liver disease, diabetes, and hyperlipidemia. Furthermore, high serum total bilirubin and creatinine levels can act as potent prognostic markers for DILI in patients with SJS/TEN.

Source: Zhang Z, Li S, Zhang Z, et al. Clinical Features, Risk Factors, and Prognostic Markers of Drug-Induced Liver Injury in Patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Indian J Dermatol. 2020;65(4):274-278.