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and Japanese patients.
Thus, the strong allopurinol- treatment to prevent the occurrence of convulsions. Considering the
specific association between HLA-B*5801 and allopurinol-induced association between the onset of SJS/TEN and infections, and the
SCAR, including SJS, TEN and DIHS, may be a universal opportunistic infection of ocular surfaces by bacteria such as
phenomenon. Interestingly, none of our 71 Japanese SJS/TEN methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-
patients with ocular complications manifested allopurinol-related resistant
Staphylococcus epidermis (MRSE), we evaluated the
SJS/TEN (Ueta et al., unpublished data). It is possible that possibility of an association between SJS/TEN and a disordered
allopurinol-induced SCAR may not elicit serious sequelae on the innate immune response.
We postulated that viral infection and/or
ocular surface. drugs may trigger a disorder in the host’s innate immune response
and that this event is followed by aggravated inflammation of the
Drugs are probably the most widely accepted aetiological factor in mucous membranes, ocular surface and skin. We also documented
It is worth noting that SJS/TEN patients often present that in Japanese SJS/TEN patients with ocular complications there
with prodromata, including non-specific fever, coryza and sore was an association with TLR3-
and IL4R polymorphisms.
throat, that closely mimic upper respiratory tract infections only genetic factors related to HLA but also innate immunity play
commonly treated with antibiotics.
The clinical records of our important roles in the integrated aetiology of SJS/TEN.
SJS/TEN patients indicated the presence of prodromata.
A group of dermatologists reported that allopurinol, uric-acid-
Yetiv et al.,
who published a retrospective analysis of the lowering drugs (17.4%) and anticonvulsant drugs such as
aetiological factors in 54 SJS patients diagnosed at Johns Hopkins carbamazepine (8.2%), nevirapine (5.5%), phenobarbital (5.3%),
hospital between 1966 and 1976, indicated that drugs and phenytoin (5.0%) and lamotrigine (3.7%) were commonly associated
infections were particularly suspect as aetiological agents in SJS. with SJS or TEN and that cotrimoxazole (6.3%), an antibiotic, was
However, they were unable to state unequivocally that drugs were also associated.
We posit that the SJS/TEN patients seen by
the aetiological factors because the prodromata of SJS include non- dermatologists are not always the same as the SJS/TEN patients
specific fever, coryza, sore throat and malaise – symptoms that consulting opthalmologists. n
closely resemble upper respiratory tract infections commonly
treated with antibiotics.
Consequently, although antibiotics are
Mayumi Ueta is an Assistant Professor at the
often suspected to play a role in the manifestation of SJS, they
Research Centre for Inflammation and Regenerative
found it difficult to ascertain whether drug treatment induced SJS or Medicine in the Faculty of Life and Medical Sciences
whether the prodromata would have developed into full-blown SJS
at Doshisha University in Kyoto and the Department
of Ophthalmology at Kyoto Prefectural University of
even without the administration of the drugs.
Japan. Her research interests are the pathophysiology
of Stevens-Johnson syndrome and innate immunity of
Of our 71 patients, 55 (77.5%) developed SJS after receiving
the ocular surface. She received her MD from Kochi
Medical School and her PhD from Kyoto Prefectural
treatment for the common cold with antibiotics, cold remedies
University of Japan.
and/or NSAIDs; only four patients (5.6%) progressed to SJS after drug
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