Acute pancreatic injuries: A complication of Stevens-Johnson syndrome/toxic epidermal necrolysis associated with cytotoxic immune cell activation.

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Complications involving internal organs are usually present in Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, pancreatic complications are rarely reported and studied.To summarize clinical characteristics of SJS/TEN-associated acute pancreatic injuries (API) and to investigate underlying inflammatory mechanisms.Clinical records of 124 inpatients with SJS/TEN were reviewed. Serum levels of tumor necrosis factor-α, interleukin (IL)-6, IL-18, IL-15, IL-12p70, and soluble CD56 were determined in 18 healthy donors and 17 patients with SJS/TEN, including three patients with API.API was diagnosed in 7.3% (9/124) of patients in the SJS/TEN cohort. Serum transaminase elevation and hypoalbuminemia occurred more frequently in patients with API compared to those without pancreatic symptoms (P = 0.004, P = 0.0002, respectively). Although API did not alter mortality rate of SJS/TEN, it was associated with longer hospitalization stays (P = 0.008). Within the serum cytokines that were elevated in SJS/TEN, only IL-18 was found to be selectively increased in patients with API compared to those without pancreatic injuries (P = 0.032).Cohort size is small.API is a gastrointestinal complication of SJS/TEN in which hepatotoxicity is more likely to occur. Overexpression of IL-18 might be involved in this unique entity.


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