A sudden increase in the syndrome of Stevens-Johnson (SJS), a rare and potentially fatal skin disease, can be triggered by COVID-19, increased vaccination rates or a lowered threshold caused by vaccines or previous infections, according to a large case series recently published in Burns.
The hospital in Australia saw two to four cases of SJS, or toxic epidermal necrolysis (TEN), per year prior to COVID-19. Only in the first six months of 2022, the same burn center observed an increase in seven times as many cases.
Of the 14 reported cases, five patients had COVID-19 one month before developing SJS/TEN and three of the 14 patients had received a COVID-19 vaccine one month before. Not a single case of SJS/TEN in an unvaccinated individual has been reported.
The researchers said the rarity of the condition and the presence of drugs known to trigger the disease make it difficult to prove the link, but the rapid increase in cases since the start of the pandemic and the vaccine rollout is “alarming”.
SJS/TEN is a severe hypersensitivity condition in which the skin develops rashes, blisters and peeling that form painful areas resembling a severe scalding from hot water. Mucous membranes, including the eyes, genitals, and mouth, are often affected or severely damaged, leading to sepsis, pneumonia, infection, or death.
Although SJS and TEN were once considered separate conditions, they are now part of the same disease, with SJS representing the less severe end of the disease spectrum and TEN representing the most severe.
Medications, including epilepsy medications, antibiotics, and anti-inflammatory painkillers, are usually the main cause of SJS/TEN, but some viruses and vaccines can also cause the condition. Due to its life-threatening nature, SJS/TEN is considered a medical emergency and patients are treated in burn units. Researchers have proposed three theories for the sudden increase in SJS/TEN cases.
SJS (from Wikipedia)
Virus induced
The first theory is that the SARS-CoV-2 virus may induce SJS/TEN by directly binding to receptors that trigger a T cell-mediated response. Other viruses known to cause SJS/TEN include herpes simplex virus, Epstein-Barr virus, and the flu.
Vaccine induced
A second theory is that COVID-19 vaccines may bind directly to the cell receptors that activate SJS/TEN and affect the body’s T-cell immune response by initiating SJS/TEN. This T-cell response peaks at seven and 28 days after vaccination, consistent with observed cases.
Of the three cases attributed to vaccination in the study, two patients had received an mRNA vaccine and one had received a viral vector vaccine within one month of developing SJS/TEN. The researchers identified eight other cases of SJS following COVID-19 vaccination in the published literature: four were associated with mRNA vaccines, three with viral vector vaccines such as AstraZeneca and Johnson & Johnson, and one with a whole virus vaccine.
According to the United States VAERS (Vaccine Adverse Event Reporting System), between December 14, 2019 and June 23, 2023, 198 cases of SJS/TEN were reported following vaccination against COVID-19. Historically, VAERS has been shown to report less than 1 percent of actual vaccine adverse events, meaning that other cases of SJS/TEN may have occurred but have not been reported.
Threshold lowering
The third theory proposed by the authors is that developing a COVID-19 infection or receiving a vaccine “primes” the immune system, lowering the threshold of sensitivity to a drug which then, in turn, triggers this dangerous syndrome .
However there is still much to be researched
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