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Mycoplasma‐Associated Stevens–Johnson Syndrome in Children: Retrospective Review of Patients Managed With or Without Intravenous Immunoglobulin, Systemic Corticosteroids, or a Combination of Therapies
Author(s) -
Ahluwalia Jusleen,
Wan Joy,
Lee Diana H.,
Treat James,
Yan Albert C.
Publication year - 2014
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.12481
Subject(s) - medicine , retrospective cohort study , mycoplasma pneumoniae , disease , systemic therapy , intravenous immunoglobulin therapy , antibody , confounding , pediatrics , immunology , pneumonia , cancer , breast cancer
Administration of intravenous immunoglobulin ( IVIG ) to patients with Stevens–Johnson syndrome ( SJS ) has been controversial. The objective of this study was to evaluate the effectiveness of IVIG , systemic corticosteroids, or both in treating Mycoplasma pneumoniae –associated SJS (mp SJS ). Retrospective series of 10 pediatric mp SJS cases were stratified into four treatment groups: IVIG alone, IVIG and systemic corticosteroids together, systemic corticosteroids alone, and supportive care. The efficacy of therapy was evaluated on the basis of several proxies of disease severity, including hospital length of stay ( LOS t ) and number of febrile days (Feb t ) after initiation of therapy. Patients treated with IVIG alone had a longer LOS t and more Feb t , despite different baseline characteristics, than patients treated with supportive therapy. Of patients who received IVIG , 50% were treated with corticosteroids concurrently and had similar characteristics of disease severity but showed a non–statistically significant trend toward shorter LOS t and fewer Feb t than those who received IVIG alone. A patient treated with corticosteroids alone had the shortest LOS t in this series. Therefore treatment with IVIG alone was associated with a more severe disease course than supportive therapy, although causality cannot be inferred given possible confounding by indication. When systemic corticosteroids were used alone or in conjunction with IVIG , hospital LOS t and Feb t trended lower than with the use of IVIG alone, although disease severity at baseline was similar between those treated with IVIG and corticosteroids concurrently and those treated with IVIG alone. It was thus concluded that treatment with systemic corticosteroids as monotherapy or in combination with IVIG may be preferable to IVIG alone. Further large‐scale studies are warranted to evaluate this hypothesis.