New Test Yields Positive Results for Stevens-Johnson Syndrome Prediction
Although rare, Stevens-Johnson syndrome (SJS) and the more severe toxic epidermal necrolysis (TEN) are each serious adverse drug eruptions that are hard to detect until severe mucocutaneous erosions appear. However once these erosions appear and the conditions are at their peak, intervention can only be administered in infection prevention, management in a burn unit, or prevention of stricture formation. If SJS or TEN is detected early, intravenous immunoglobulin therapy can be used to stop or slow progression. In light of this, the recently developed rapid immunochromatographic test for elevated serum granulysin may be a very useful tool.
In a recent study, it was found that high concentrations of granulysin are present in SJS/TEN blisters. When studied further, the granulysin levels showed elevation before erosions appeared and dropped significantly within 5 days of the start of SJS/TEN. This data was used to develop a rapid immunochromatographic test that shows, in only 15 minutes, a visible result if at least 10 ng/mL of serum granulysin is present in the patient.
Sensitivity resulted 80% and specificity was 95.8% in the trial of the rapid immunochromatographic test. 5 SJS/TEN patients, 31 healthy subjects (controls) and 24 non-SJS/TEN “ordinary drug-induced skin reaction” patients (ODSRs) were tested. The results showed positive bands for 4 of the 5 SJS/TEN. In comparison, only 1 of the 24 ODSRs and 0 controls showed positive bands.
Although a negative test result cannot be used to rule out SJS/TEN, the simplicity and rapid-result nature of the test is very promising to detect the subset of drug eruptions that can progress into SJS/TEN. If this is found before SJS/TEN erosions appear, early intervention is possible such as the aforementioned intravenous immunoglobulin therapy.
“Fujita and colleagues should be commended for designing an elegant, simple, and rapid immunochromatographic test for elevated serum granulysin levels. If future larger studies confirm that this screening test is both sensitive and specific for SJS/TEN, then it should see immediate clinical use.”
Source: Graem M. Lipper, MD viewpoint on: Fujita Y, Yoshioka N, Abe R, et al
J Am Acad Dermatol. 2011; 65:65-68
[image by Tulanesally]