Can You Have an Elevated CRP Post Stevens-Johnson Syndrome?
Yes, patients can absolutely have elevated C-reactive protein (CRP) levels during and after Stevens-Johnson syndrome (SJS), as CRP rises in response to the severe inflammatory state characteristic of this hyperergic reaction. 1
Evidence from Stevens-Johnson Syndrome
A documented case report specifically tracking inflammatory markers in SJS demonstrated that CRP levels become elevated during the active disease phase and follow the clinical course of the illness 1. In this case:
- CRP values increased during the acute inflammatory phase of SJS
- CRP followed the disease activity curve with approximately a 4-day delay compared to neopterin (another inflammatory marker)
- CRP levels correlated with disease severity and helped monitor disease regression 1
Understanding CRP Elevation in SJS Context
CRP is an acute-phase protein produced by the liver in response to inflammatory cytokines (particularly IL-6 and TNF-α), and can increase up to 1000-fold rapidly after the onset of inflammation 2. Stevens-Johnson syndrome represents a severe mucocutaneous hypersensitivity reaction that triggers significant systemic inflammation, making CRP elevation an expected finding 1.
Expected CRP Patterns:
- During acute SJS: CRP rises significantly as part of the inflammatory response 1
- Post-SJS recovery: CRP should decrease as inflammation resolves, though the timeline varies 1, 2
- Persistent elevation: If CRP remains elevated after clinical resolution, this warrants investigation for complications or alternative causes 3, 4
Clinical Interpretation Considerations
If you encounter elevated CRP in a patient with a history of SJS, the key question is timing 4:
During Active Disease:
- Elevated CRP is expected and correlates with disease activity 1
- Serial CRP measurements can help monitor treatment response and disease regression 1
- CRP typically decreases rapidly with resolution of inflammation 2
After Disease Resolution:
CRP >10 mg/L persisting after clinical recovery should prompt evaluation for:
CRP 3-10 mg/L may indicate:
Important Pitfalls to Avoid
Do not attribute persistently elevated CRP solely to resolved SJS without excluding active infection or other inflammatory processes 3, 4. The American College of Cardiology and other societies emphasize that CRP >10 mg/L strongly suggests an active inflammatory or infectious process requiring investigation 3.
A single normal CRP should not be used to rule out infection, as serial measurements are more valuable 3. Approximately 88% of extreme CRP elevations (>500 mg/L) are due to bacterial infections, with high mortality rates particularly in patients with comorbidities 5.