Abstract
Background: Toxic-Epidermal-Necrolysis might be a severe delayed reaction to drugs, so in-vitro assessment could be suitable. To date there are not validated diagnostic procedures for such cases. Methods: A 33 year-old female suffering from Multiple-Sclerosis (MS) was receiving Beta1a-Interferon from the last 2.5 months, Deflazacort 1 month and Ibuprofen occasionally. She consulted the emergency department due to confluent dianiform maculae, denudating blisters and subsequent systemic symptoms which led to toxic epidermal necrolysis after skin biopsy result. Cyclosporine, Prednisone, Zinc-Sulfate baths and complete discontinuation of implicated medication achieved total symptom relief. A Basophil Activation Test (BAT) and Lymphocyte-Transformation- Test (LTT) were carried out using Beta1aInterferon, Deflazacort and Ibuprofen at different dilutions for each culprit medication (1/1,1/10,1/102,1/103). Glatiramer-Acetate(GA) hasn´t been reported as TEN/SJS cause, therefore neurology-department considered it as a secure alternative to Beta-1a-Interferon so it was in-vitro assessed likewise. Results: BAT and LTT results were inconclusive. In vivo tests: Intradermal test to GA at progressive dilutions (1/1,1/10,1/102,1/103,1/104,1/105) resulted negative. Oral Challenge Tests to Acetaminophen-1 mg, Prednisone-30 mg and 1-gram Intravenous Methyl-prednisolone resulted negative. Conclusion: Up-to-date cutaneous lesions limited to injection sites have been reported following Beta-1a interferon treatment but the former had not been involved in a widespread reaction yet. We present a rare case of TEN due to several drugs in which in-vitro tests have been unhelpful, to manage this condition. Further studies would be helpful to clarify its suitability, mainly in immunomodulating medication.
Highlights
Toxic-Epidermal-Necrolysis might be a severe delayed reaction to drugs, so in-vitro assessment could be suitable
Toxic Epidermal Necrolysis (TEN) is a rare but life-threatening cutaneous eruption with systemic features mainly caused by drugs in which there is at least 30% of skin detachment so in-vitro assessment might be useful to avoid insecure drug challenges [1]
Allergy study was performed after informed consent: A Basophile activation Test (BAT) and Lymphocyte-TransformationTest (LTT) were carried out in order to elucidate the etiology of this complex Syndrome
Summary
A 33 year-old female suffering from Multiple-Sclerosis (MS) was receiving Beta1a-Interferon from the last 2.5 months, Deflazacort 1 month and Ibuprofen occasionally. She consulted the emergency department due to confluent dianiform maculae, denudating blisters and subsequent systemic symptoms which led to toxic epidermal necrolysis after skin biopsy result. Cyclosporine, Prednisone, Zinc-Sulfate baths and complete discontinuation of implicated medication achieved total symptom relief. A Basophil Activation Test (BAT) and Lymphocyte-TransformationTest (LTT) were carried out using Beta1aInterferon, Deflazacort and Ibuprofen at different dilutions for each culprit medication (1/1,1/10,1/102,1/103). Glatiramer-Acetate(GA) hasnt been reported as TEN/SJS cause, neurology-department considered it as a secure alternative to Beta-1a-Interferon so it was in-vitro assessed likewise
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: Journal of Clinical & Experimental Dermatology Research
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
