Serum Granulysin in Differentiation of Stevens-Johnson Syndrome/toxic Epidermal Necrolysis and Erythema Multiforme

Tran Thi Huyen; Pham Dinh Hoa; Trinh Minh Trang; Riichiro Abe; Nguyen Van Thuong; Pham Thi Lan; Michael Tirant

doi:10.3889/oamjms.2020.4905

Authors

Tran Thi Huyen Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin Diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
Pham Dinh Hoa Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin Diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
Trinh Minh Trang Department of Skin Diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
Riichiro Abe Department of Dermatology, Niigata University, Japan
Nguyen Van Thuong Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin Diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
Pham Thi Lan Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam; Department of Skin Diseases of Women and Children, National Hospital of Dermatology and Venereology, Hanoi, Vietnam
Michael Tirant Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam

DOI:

https://doi.org/10.3889/oamjms.2020.4905

Keywords:

Stevens-Johnson syndrome, Toxic epidermal necrolysis, Serum granulysin, Erythema multiforme, re-epithelialization, SCORTEN

Abstract

BACKGROUND: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute, life-threatening drug reactions, which lead to massive epidermal necrolysis. Granulysin plays an important role as a key mediator for keratinocyte apoptosis in these conditions. Erythema multiforme (EM) may have skin manifestation similar to SJS/TEN.

AIMS: The aim of the study was to compare serum granulysin levels in patients with SJS/TEN and EM as well as to investigate a possible association between serum granulysin levels and the severity of SJS/TEN.

METHODS: In total, 48 patients with SJS/TEN, 43 patients with EM, and 20 health controls (HCs) were enrolled. We measured serum granulysin levels using enzyme-linked immunosorbent assay.

RESULTS: The average level of serum granulysin in the SJS/TEN patients was 23.0 ng/ml (range 1.2–144.6 ng/ml), significantly higher than that of EM group (20.1 ng/ml; range 8.5–121 ng/ml, p < 0.05) and HCs group (20.8 ng/ml; range 10.1–46.7 ng/ml, p < 0.05). Of 48 SJS/TEN patients, the 25 samples collected <6 days after onset showed higher level of serum granulysin (27.7 ng/ml; range 2.5–144.6 ng/ml) than those collected ≥6 days after onset (17.9 ng/ml; range 1.2–59 ng/ml; p > 0.05). No significant correlation was found between serum granulysin levels and the body surface area affected and the modified-SCORTEN. At the day of re-epithelialization, serum granulysin levels were not different compared with those at the day of hospitalization.

CONCLUSIONS: Serum granulysin levels are significantly higher in SJS/TEN group than in EM group. After the onset, serum granulysin levels in patients with SJS/TEN are not a good biomarker to evaluate the severity of the diseases.

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