A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid
Toxic epidermal necrolysis (TEN), a severe form of Stevens-Johnson syndrome, is an acute life-threatening adverse drug reaction with a mortality rate of approximately 30%. Primary treatment of TEN is usually supportive. The use of intravenous immunoglobulin (IVIG) and corticosteroids are still uncer...
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| Format: | Article |
| Language: | English |
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Oman Medical Specialty Board
2018-07-01
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| Series: | Oman Medical Journal |
| Subjects: | |
| Online Access: | http://omjournal.org/articleDetails.aspx?coType=1&aId=2133 |
| _version_ | 1818293859088596992 |
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| author | Lutfi Al-Kathiri Varghese Mercyamma Tasneem Al-Najjar |
| author_facet | Lutfi Al-Kathiri Varghese Mercyamma Tasneem Al-Najjar |
| author_sort | Lutfi Al-Kathiri |
| collection | DOAJ |
| description | Toxic epidermal necrolysis (TEN), a severe form of Stevens-Johnson syndrome, is an acute life-threatening adverse drug reaction with a mortality rate of approximately 30%. Primary treatment of TEN is usually supportive. The use of intravenous immunoglobulin (IVIG) and corticosteroids are still uncertain, as there are only a limited number of studies comparing the usefulness of these treatments. We report a case of a Filipino male patient who developed TEN, most likely due to one of the medications he received during his course of illness. The patient was admitted to Sultan Qaboos Hospital, Salalah, with fever and diffuse painful maculopapular eruption, which became vesicular and bullous after few days, followed by shedding of large sheets of the epidermis. The patient was admitted initially under medical care, and a diagnosis of TEN was considered later. All unnecessary drugs were discontinued, and the patient was shifted to the burns unit. In addition to standard supportive treatment, a combination therapy of systemic steroid and a low-dose IVIG (1.2 g/kg) divided over three days was administered. This low-dose regimen of IVIG has a pharmacoeconomic benefit compared with the previous cumulative dose (3 g/kg), which is usually given by dermatologists in other institutions to patients with TEN. The outcome was excellent, and the condition recovered almost completely two weeks after starting the treatment without sequelae. |
| first_indexed | 2024-12-13T03:22:33Z |
| format | Article |
| id | doaj.art-d5f177563eaf4d3a842cc15cda411203 |
| institution | Directory Open Access Journal |
| issn | 1999-768X 2070-5204 |
| language | English |
| last_indexed | 2024-12-13T03:22:33Z |
| publishDate | 2018-07-01 |
| publisher | Oman Medical Specialty Board |
| record_format | Article |
| series | Oman Medical Journal |
| spelling | doaj.art-d5f177563eaf4d3a842cc15cda4112032022-12-22T00:01:20ZengOman Medical Specialty BoardOman Medical Journal1999-768X2070-52042018-07-0133435635910.5001/omj.2018.65A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic CorticosteroidLutfi Al-Kathiri0Varghese Mercyamma1Tasneem Al-Najjar2 Department of Dermatology, Sultan Qaboos Hospital, Salalah, Oman Department of Dermatology, Sultan Qaboos Hospital, Salalah, Oman Department of Dermatology, Sultan Qaboos Hospital, Salalah, OmanToxic epidermal necrolysis (TEN), a severe form of Stevens-Johnson syndrome, is an acute life-threatening adverse drug reaction with a mortality rate of approximately 30%. Primary treatment of TEN is usually supportive. The use of intravenous immunoglobulin (IVIG) and corticosteroids are still uncertain, as there are only a limited number of studies comparing the usefulness of these treatments. We report a case of a Filipino male patient who developed TEN, most likely due to one of the medications he received during his course of illness. The patient was admitted to Sultan Qaboos Hospital, Salalah, with fever and diffuse painful maculopapular eruption, which became vesicular and bullous after few days, followed by shedding of large sheets of the epidermis. The patient was admitted initially under medical care, and a diagnosis of TEN was considered later. All unnecessary drugs were discontinued, and the patient was shifted to the burns unit. In addition to standard supportive treatment, a combination therapy of systemic steroid and a low-dose IVIG (1.2 g/kg) divided over three days was administered. This low-dose regimen of IVIG has a pharmacoeconomic benefit compared with the previous cumulative dose (3 g/kg), which is usually given by dermatologists in other institutions to patients with TEN. The outcome was excellent, and the condition recovered almost completely two weeks after starting the treatment without sequelae.http://omjournal.org/articleDetails.aspx?coType=1&aId=2133Stevens-Johnson SyndromeDrug EruptionsDrug-Related Side Effects and Adverse ReactionsImmunoglobulinsIntravenous |
| spellingShingle | Lutfi Al-Kathiri Varghese Mercyamma Tasneem Al-Najjar A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid Oman Medical Journal Stevens-Johnson Syndrome Drug Eruptions Drug-Related Side Effects and Adverse Reactions Immunoglobulins Intravenous |
| title | A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid |
| title_full | A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid |
| title_fullStr | A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid |
| title_full_unstemmed | A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid |
| title_short | A Case of Toxic Epidermal Necrolysis Successfully Treated with Low Dose Intravenous Immunoglobulins and Systemic Corticosteroid |
| title_sort | case of toxic epidermal necrolysis successfully treated with low dose intravenous immunoglobulins and systemic corticosteroid |
| topic | Stevens-Johnson Syndrome Drug Eruptions Drug-Related Side Effects and Adverse Reactions Immunoglobulins Intravenous |
| url | http://omjournal.org/articleDetails.aspx?coType=1&aId=2133 |
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