史蒂文生氏-強生症候群(Stevens-Johnson syndrome;SJS)及毒性表皮細胞壞死溶解症(Toxic epidermal necrolysis;TEN)是一種廣泛性皮膚壞死的疾病,致死率約30-50%。目前已初步了解致病機轉可能與 keratinocytes 及 lymphocytes 的細胞凋亡途徑有關。本案例是一位 85 歲男性病患,診斷出右側肺炎引起敗血症,給予經驗性抗生素治療,另外因病患還有肝功能不全、高血壓性心血管疾病及泌尿道感染。住院期間曾使用 diphenylhydantoin、indomethacin、ketorolac、rifampin、isoniazide、vancomycin 6 種藥物,疑似造成 SJS 及 TEN。在發現可能是藥物造成的 SJS 或 TEN後,病情迅速由 SJS 演變成大範圍皮膚壞死的 TEN,且出現敗血性休克及多重器官衰竭而病逝。期藉由本案例對致病機轉的了解,探討更有效的治療方式及未來可能的治療或預防方法。

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), 30-50% mortality rate, are characterized by widespread epidermal death, which may result from apoptosis of keratinocytes and lymphocytes. In one case, 85 year old male patient diagnosed in sepsis caused by right side pneumonia, combined with liver function impairment, hypertensive cardiovascular disease, and urinary tract infection. During hospitalization, diphenylhydantoin, indomethacin, ketorolac, rifampin, isoniazide, and vancomycin were used. The patient expired by septic shock, multiple organ failure, and progressed form SJS to TEN. Because of this case, we reviewed the literature on the mechanism and clinical management of SJS and TEN.