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Fatal outcome of toxic epidermal necrolysis- a case report

Aims: Toxic epidermal necrolysis (TEN) is severe drug reaction with low incidence and high mortality race characterized with severe and extensive skin detachment. TEN and Stevens Johnson syndrome (SJS) differ only in severity and are characterized with keratinocyte apoptosis and separation of epidermis and dermis. Methods: We present clinical course of patient with TEN with fatal outcome.Results: Female patient aged 75 yrs was admitted to our Department due to severe drug reaction occured 6 days prior to hospitalization. Patient had hypertension, diabetes mellitus, anaemia, hyprelipidaemia and has been prescribed new medications 2 weeks prior to hospitalization: Lansoprasole, Ramipril+Hydrochlorothiazide, Amlodipine. She was taking Bisoprolol few months before hospitalization. Pruritus occured 2 days after introduction of new drugs and shortly after diffuse urticarial exanthema and joint swelling occured. All medications were excluded immediately but exanthema progressed inspite of parenteral antihistamines and corticosteroid therapy. First day diffuse confluent urticarial and macular exanthema was found, partially confluenting in wide erythematous areas with large flaccid bullas and erosions, especially intertriginously, on genitalia and trunk. Iris-like lesions were found on hands. Only face was partially spared. Genital region and oral mucosa were also affected. Exanthema progressed into erythrodermia in few next days followed by diffuse skin shedding. Skin smear showed Staphylococcus aureus. Due to laboratory and clinical signs of systemic infection, systemic antibiotic therapy was introduced. Due to severe skin exfoliation at 5th day of hospitalization (aproximatelly 80%) patient was transferred to Intensive Care Unit and died in few next days due to progression of sepsis and severe loss of fluid. Conclusions: TEN has high mortality rate (20-30%). Severity of disease depends on affected skin surface: the more the skin is affected, the more severe prognosis is. Prompt referral to specialized unit is necessary.

Toxie epidermal necrolysis; fastal outcome; Stevens-Johnson syndrome; case report

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