Clinical, etiologic, and histopathologic features of Stevens-Johnson syndrome during an 8-year period at Mayo Clinic

Mayo Clin Proc. 2010 Feb;85(2):131-8. doi: 10.4065/mcp.2009.0379.


Objective: To examine clinical, etiologic, and histologic features of Stevens-Johnson syndrome and to identify possible correlates of clinical disease severity related to etiologic and histopathologic findings.

Patients and methods: This is a retrospective review of patients seen at Mayo Clinic between January 1, 2000, and December 31, 2007.

Results: Of 27 patients (mean age, 28.1 years), 22 (81%) had involvement of 2 or more mucous membranes, and 19 (70%) had ocular involvement. Medications, most commonly antibiotics and anticonvulsants, were causative in 20 patients. Mycoplasma pneumoniae infection caused 6 of the 27 cases. Corticosteroids were the most common systemic therapy. No patients with mycoplasma-induced Stevens-Johnson syndrome had internal organ involvement or required treatment in the intensive care unit, in contrast to 4 patients each in the drug-induced group. Three patients had chronic ocular sequelae, and 1 died of complications. Biopsy specimens from 13 patients (48%) showed epidermal necrosis (8 patients), basal vacuolar change (10 patients), and subepidermal bullae (10 patients). Biopsy specimens from 11 patients displayed moderate or dense dermal infiltrate. Histologic features in drug-induced cases included individual necrotic keratinocytes, dense dermal infiltrate, red blood cell extravasation, pigment incontinence, parakeratosis, and substantial eosinophils or neutrophils.

Conclusion: Our clinical and etiologic findings corroborate those in previous reports. M pneumoniae-induced Stevens-Johnson syndrome manifested less severely than its drug-induced counterpart. The limited number of biopsies precludes unequivocal demonstration of histopathologic differences between drug-induced and M pneumoniae-induced Stevens-Johnson syndrome.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Anti-Bacterial Agents / adverse effects
  • Anti-Inflammatory Agents / therapeutic use
  • Anticonvulsants / adverse effects
  • Biopsy
  • Causality
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Minnesota / epidemiology
  • Outpatient Clinics, Hospital
  • Pneumonia, Mycoplasma / complications
  • Prognosis
  • Retrospective Studies
  • Severity of Illness Index*
  • Stevens-Johnson Syndrome / drug therapy
  • Stevens-Johnson Syndrome / epidemiology
  • Stevens-Johnson Syndrome / etiology*
  • Stevens-Johnson Syndrome / pathology*


  • Anti-Bacterial Agents
  • Anti-Inflammatory Agents
  • Anticonvulsants