Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In a...Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition,we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990- 2003) at the Asan Medical Center was performed. The mean involved body surface area was 49± 17% . All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8± 5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5% , 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)=0.425; 95% CI, 0.011- 2.368), whereas corticosteroid therapy showed no such difference (SMR=1.004; 95% CI, 0.369- 2.187).展开更多
Introduction: Lyell’s syndrome (SL), called Toxic Epidermal Necrolysis is one of the most serious forms of medication accidents. It is an acute, rare pathology, its incidence is estimated at 1 to 2 cases out of one m...Introduction: Lyell’s syndrome (SL), called Toxic Epidermal Necrolysis is one of the most serious forms of medication accidents. It is an acute, rare pathology, its incidence is estimated at 1 to 2 cases out of one million inhabitants per year and its evolution can be fatal. Materials and Methods: We report the observation of a 60-year-old patient, with no significant pathological history, admitted to our intensive care unit at the Renaissance University Teaching Hospital in N’Djamena for the treatment of Toxic Epidermal Necrolysis. In whom the onset of symptoms dates back to few hours after vaccination against COVID-19 with Ag Johnson and Johnson. Results: An ophthalmology opinion was requested and the patient was put on Fucithalmic. In our case, in addition to the advanced age of the patient (60 years old), her SCORTEN was ≥5. Conclusion: The late management as well as the absence of a specific department for severe burns, which condition the presence of a technical plate was fatal to her despite multidisciplinary care: Resuscitators, Traumato-Orthopedist and ophthalmologist.展开更多
文摘Toxic epidermal necrolysis (TEN) is a rare, life-threaten-ing, drug-induced cutaneous reaction. We herein report our experience regarding causes, clinical course, treatment and sequelae of TEN in Korean patients. In addition,we used the SCORTEN, a severity-of-illness score for TEN, to compare the predicted and actual mortality rates, and to evaluate the efficacy of treatment modalities. A retrospective study of 38 patients with TEN during a 13- year period (1990- 2003) at the Asan Medical Center was performed. The mean involved body surface area was 49± 17% . All except three cases were associated with medications, most commonly antibiotics, followed by non-steroidal anti-inflammatory drugs, acetaminophen and herbal remedies. Fourteen patients had a history of current infection, including upper respiratory infection, pneumonia and herpes simplex infection. The mean time from initial drug administration to the onset of TEN was 9.8± 5.7 days. Twenty-one patients were treated with systemic corticosteroids. Fourteen received high dose intravenous immunoglobulin therapy. The actual mortality rate was 23.7% (9/38), not significantly different from the SCORTEN-predicted rate (25.5% , 9.699/38). Also based on SCORTEN, treatment with high dose intravenous immunoglobulin showed a trend to lower actual mortality than predicted mortality (standardized mortality ratio (SMR)=0.425; 95% CI, 0.011- 2.368), whereas corticosteroid therapy showed no such difference (SMR=1.004; 95% CI, 0.369- 2.187).
文摘Introduction: Lyell’s syndrome (SL), called Toxic Epidermal Necrolysis is one of the most serious forms of medication accidents. It is an acute, rare pathology, its incidence is estimated at 1 to 2 cases out of one million inhabitants per year and its evolution can be fatal. Materials and Methods: We report the observation of a 60-year-old patient, with no significant pathological history, admitted to our intensive care unit at the Renaissance University Teaching Hospital in N’Djamena for the treatment of Toxic Epidermal Necrolysis. In whom the onset of symptoms dates back to few hours after vaccination against COVID-19 with Ag Johnson and Johnson. Results: An ophthalmology opinion was requested and the patient was put on Fucithalmic. In our case, in addition to the advanced age of the patient (60 years old), her SCORTEN was ≥5. Conclusion: The late management as well as the absence of a specific department for severe burns, which condition the presence of a technical plate was fatal to her despite multidisciplinary care: Resuscitators, Traumato-Orthopedist and ophthalmologist.
