Granulysin as a Marker for Early Diagnosis of the Stevens–Johnson Syndrome
Authors: Riichiro Abe, Naoya Yoshioka, Junko Murata, Yasuyuki Fujita, Hiroshi Shimizu
Journal: Annals of Internal Medicine (2009)

Letters6 October 2009Granulysin as a Marker for Early Diagnosis of the Stevens–Johnson SyndromeRiichiro Abe, MD, PhD, Naoya Yoshioka, MS, Junko Murata, MD, Yasuyuki Fujita, MD, and Hiroshi Shimizu, MD, PhDRiichiro Abe, MD, PhDFrom Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan., Naoya Yoshioka, MSFrom Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan., Junko Murata, MDFrom Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan., Yasuyuki Fujita, MDFrom Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan., and Hiroshi Shimizu, MD, PhDFrom Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-151-7-200910060-00016 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: The Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening adverse drug reactions characterized by massive epidermal necrosis. In the early stage, clinical presentations of SJS/TEN are very similar to those of ordinary drug-induced skin reactions (ODSRs); therefore, SJS/TEN is difficult to diagnose and the start of treatment is often delayed, resulting in high mortality rates. Other investigators (1) reported that granulysin is highly expressed in blisters of SJS/TEN and causes disseminated keratinocyte death. Because SJS/TEN progresses and spreads rapidly, the granulysin level should be increased in the serum of patients with active SJS/TEN if it is a ...References1. Chung WH, Hung SI, Yang JY, Su SC, Huang SP, Wei CY, et al. Granulysin is a key mediator for disseminated keratinocyte death in Stevens-Johnson syndrome and toxic epidermal necrolysis. Nat Med. 2008;14:1343-50. [PMID: 19029983] CrossrefMedlineGoogle Scholar2. Ogawa K, Takamori Y, Suzuki K, Nagasawa M, Takano S, Kasahara Y, et al. Granulysin in human serum as a marker of cell-mediated immunity. Eur J Immunol. 2003;33:1925-33. [PMID: 12884856] CrossrefMedlineGoogle Scholar3. Murata J, Abe R, Shimizu H. Increased soluble Fas ligand levels in patients with Stevens-Johnson syndrome and toxic epidermal necrolysis preceding skin detachment. J Allergy Clin Immunol. 2008;122:992-1000. [PMID: 18692887] CrossrefMedlineGoogle Scholar4. Kaspar AA, Okada S, Kumar J, Poulain FR, Drouvalakis KA, Kelekar A, et al. A distinct pathway of cell-mediated apoptosis initiated by granulysin. J Immunol. 2001;167:350-6. [PMID: 11418670] CrossrefMedlineGoogle Scholar5. Abe R, Shimizu T, Shibaki A, Nakamura H, Watanabe H, Shimizu H. Toxic epidermal necrolysis and Stevens-Johnson syndrome are induced by soluble Fas ligand. Am J Pathol. 2003;162:1515-20. [PMID: 12707034] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Riichiro Abe, MD, PhD; Naoya Yoshioka, MS; Junko Murata, MD; Yasuyuki Fujita, MD; Hiroshi Shimizu, MD, PhDAffiliations: From Hokkaido University Graduate School of Medicine, Sapporo 060-8638, Japan.Disclosures: None disclosed. 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