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Medical/Surgical/Diseases/Complications

Poster Session 3

(853) Outcomes of Stevens-Johnson syndrome and toxic epidermal necrolysis in pregnant women, 2009-2020

Wednesday, February 14, 2024
8:30 AM – 10:00 AM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level
Objective: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rarely described in the pregnant population, and little is known about their impact on the mother and developing fetus. We aim to describe SJS/TEN in pregnant women and to investigate the risk factors for developing SJS/TEN in pregnancy.

Study Design: We utilized hospitalization data from the 2009-2020 National Inpatient Sample. Pregnancy hospitalizations and SJS/TEN involvement were identified by ICD-9/10 codes and analyzed by chi-square and logistic regression.

Results: We identified 650 pregnancies complicated by SJS/TEN requiring hospitalization. The median age was 28 (IQR: 23-32) years, and the majority of patients were non-Hispanic white (55.2%). There were ≤10 cases of mortality in the cohort. Among cases with trimester data, 73.9% of SJS/TEN cases occurred during the third trimester. In the multivariable logistic regression model, HIV infection (OR=9.49; 95% CI=1.24-7.24; p=0.030), herpes simplex virus (HSV) infection (OR=2.49; 95% CI=1.15-5.41; p=0.021), genitourinary tract (GU) infections (OR=3.80; 95% CI=2.01-7.16; p< 0.001), malignant neoplasm (OR=8.67; 95% CI=1.22-61.39; p=0.031), and lupus (OR=41.94; 95% CI=20.78-84.66; p< 0.001) were associated with increased odds of developing SJS/TEN in pregnancy. Of 650 pregnant patients with SJS/TEN, 378 delivered during the hospitalization. The rates of preterm births were higher in the SJS/TEN cohort, 16.9% versus 8.2% (p< 0.001). There were no significant differences in frequency of pre-eclampsia, stillbirths, and post-term births compared to the non-SJS/TEN pregnancy cohort.

Conclusion: Although rare, SJS/TEN in pregnancy is associated with favorable perinatal outcomes aside from an increase in preterm birth. The high prevalence of SJS/TEN in the third trimester may reflect the inflammatory state of the late third trimester. Lupus, malignancy, HIV, and to lesser degrees, HSV and GU infection should be considered in the differential diagnosis.