In a Patient With Toxic Epidermal Necrolysis, Does Intravenous Immunoglobulin Improve Survival Compared With Supportive Care?

Abstract

Clinical Question: A 67-year-old Chinese man presented with pain and widespread skin erythema and detachment. A clinical diagnosis of toxic epidermal necrolysis (TEN) was made, which was supported by skin biopsy findings. The TEN was thought to be due to recent initiation of lamotrigine for mild epilepsy, and the drug was stopped immediately. The severity of TEN, measured by the Severityof-Illness Score for Toxic Epidermal Necrolysis (SCORTEN) scale, was 3 on admission owing to renal impairment, indicating a mortality risk of 35%. The patient was transferred to the burns unit for close monitoring of temperature, fluid balance, and appropriate dressings for his affected skin. A debate ensued among the dermatology, plastic surgery, and intensive care teams responsible for his care about whether intravenous immunoglobulin (IVIg) should be added to his treatment because improvement was slow with conservative treatment.