Sepsis assessment in SJS/TEN: an important point overlooked? - Reply^☆,☆☆

We were pleased to read the additional commentary on our article by Khurana et al.¹ with the insight of adding procalcitonin as a serum marker for sepsis in severe epidermal necrolysis (EN) patients.

In many patients fever is attributed to the general inflammatory chaos of EN. Since prophylactic antibiotic therapy is not a standard routine and some patients have fever as an isolated infection signal, it seems reasonable to adopt a laboratory test to evaluate the likelihood of sepsis in patients with tachycardia, fever, or any other laboratory or clinical sign of infection not prompting antibiotic therapy. Thus, procalcitonin may be most helpful in the context of the initial expectant approach. A positive result should prompt change in intervention, and a negative result would be reassuring.

Hypothermia, on the other hand, could be a more specific clinical sign of sepsis. However, it is known to be associated with poor prognosis.² Recently, procalcitonin > 1 µg/L and also hypothermia were associated with positive blood cultures in EN patients.³

Despite the presence of sepsis, therapeutic immunosuppression must not be delayed in patients with high SCORTEN. During the chart review⁴ some fatal cases were not prescribed systemic immunosuppression because of the possibility of sepsis, in a period of clinical decision preceding SCORTEN. Many of those patients could have had a different outcome if clinicians were aware that prediction of death was the most likely event according to SCORTEN, a game-changer in the treatment of EN.

• Financial support
  None declared.
• ☆
  How to cite this article: Wambier CG, Wambier SP. “Sepsis assessment in SJS/TEN: an important point overlooked?” - Reply. An Bras Dermatol. 2019;94:774.
• ☆☆
  Study conducted at the Department of Dermatology - Yale University School of Medicine, New Haven, United States.

References

• ¹
  Khurana A, Sharma MK, Sardana K. Sepsis assessment in SJS/TEN: an important point overlooked? An Bras Dermatol. 2019;94:777-8.
• ²
  Rumbus Z, Matics R, Hegyi P, Zsiboras C, Szabo I, Illes A, et al. Fever is associated with reduced, hypothermia with increased mortality in septic patients: a meta-analysis of clinical trials. PLOS ONE. 2017;12,e0170152.
• ³
  Koh HK, Chai ZT, Tay HW, Fook-Chong S, Choo KJL, Oh CC, et al. Risk factors and diagnostic markers of bacteraemia in Stevens-Johnson syndrome and toxic epidermal necrolysis: a cohort study of 176 patients. J Am Acad Dermatol. 2019;81:686-93.
• ⁴
  Wambier CG, Hoekstra TA, Wambier SPF, Bueno Filho R, Vilar FC, Paschoal RS, et al. Epidermal necrolysis: SCORTEN performance in AIDS and non-AIDS patients. An Bras Dermatol. 2019;94:17-23.

Publication Dates

• Publication in this collection
  03 Feb 2020
• Date of issue
   2019

History

• Received
  3 June 2019
• Accepted
  21 June 2019