Pathogenesis
- Nearly always drug-related!
- Other causes: viral/ mycoplasma infections (debated)
- Most common drugs:
- Allopurinol
- Aminopenicillins
- Antiretrovirals (non-nucleoside reverse transcriptase inhibitors)
- Barbiturates
- Carbamazepine
- Cephalosporins
- Checkpoint inhibitors
- Chlormezanone
- Phenytoin
- Lamotrigine (especially when combined with valproic acid)
- Phenylbutazone
- Piroxicam
- Quinolones
- Sulfonamide antibiotics
- Sulfasalazine
- Suspect drugs that were initiated within 1 month of symptom onset (usually 7-14 days)
- Medications with long half-lives cause more fatal reactions
- Cytotoxic (NK/CD8) immune responses directed against keratinocytes that express drug and infectious antigens that lead to keratinocyte apoptosis involving:
- Fas ligand (FasL, CD95L) and Fas (CD95, Apo-1)
- Granulysin
- Serum IL-15 level correlate with severity and mortality rate.