Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Reactions to Ibuprofen and Acetaminophen: Clinical, Laboratory Assessment Using In Vitro Lymphocyte Toxicity Assay to Personalized Therapy

Neuman Manuela*, Salisbury Roger and Misha Montfort

Introduction: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are serious cutaneous adverse reactions (SCARs). SJS is defined when 10% of the body’s skin is involved. When epidermal detachment involves 30% or more, it is called TEN. The syndrome affects 1-12 cases per million patients. The risk of death for SJS is 5-10%, and for TEN, 25% -50%. We used our proprietary test lymphocyte toxicity assay (LTA) to identify SJS/TEN to several medications. In this article, we present the role of LTA to personalize the diagnosis of acetaminophen (APAP) and ibuprofen-induced SJS-TEN.

Aims: -to ensure that the cases of SJS and TEN clinically assessed by a burn surgeon and having positive skin biopsies correlate with the positive in vitro LTA results, to ibuprofen/ APAP,

-to identify defects in the mmune-responses of the SJS and TEN patients and confirm the validity of using LTA for the causality assessment for SJS and TEN from acetaminophen and ibuprofen.

Material and Methods: Patients with biopsy-proven SJS and TEN agreeing to send their blood to our laboratory have been enrolled in the study. Each one of the individual samples had a control sample given by one of the parents. The LTA was performed at the same time as the control and the patient, and the results were sent to the clinic. Also, we performed cytokine and chemokine analysis to understand the role of the immune system in the disease.

Results: There were samples of Black (3) and Caucasian (3) children; 2 teenage males (1 Hispanic, 1 Black); 3 females (1 Caucasian, 1 Filipino, 1 Hispanic). The LTA positive results are shown in the table. Analysis of proinflammatory cytokines showed a high level of inflammation.

Discussion: The study found that accurate differential diagnosis is a crucial step in identifying true immune-mediated hypersensitivity reactions (HSR), which differ from pseudo-allergic conditions. This approach minimizes the risks to the patient associated with improper treatment or medications.

Determining the type of HSR, considering immunological reactions and laboratory analysis, permits a clear diagnosis, emphasizing the need for a comprehensive approach to diagnosis of SCAR events, which includes clinical history and the use of personalized laboratory methods.

Conclusion: Treating patients with SCARS is a continuous collaboration between the clinical and laboratory teams. Personalized medicine is the solution to propose to the patients.

Keywords:

Published on: May 1, 2026 Pages: 1-16

Full Text PDF Full Text HTML DOI: 10.17352/ijdcr.000057
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