Abstract
Body reactions to drugs can manifest as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). TEN is the most severe form of cutaneous reactions with an incidence rate of 1-2 per million cases per year. Despite TEN being a critical and life-threatening condition, there is little to no evidence of clear management protocol. We reported a 5-year-old male child who presented with lamotrigine-induced TEN and was successfully treated with intravenous immune globulin (IVIG) with a burn unit care level, while TEN treatment with IVIG is an appropriate approach with predictable good outcomes, burn unit care is also effective in creating highly favorable effects. Upon reviewing the literature, several studies indicate that TEN patients treated with the combination of IVIG and burn unit care lead to decreased levels of morbidity and mortality than when treated with IVIG or burn unit care alone. Therefore, treatment involving both IVIG and burn unit care should be considered for TEN patients.
Highlights
Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction to drugs or their metabolites with multisystem involvement
With a high mortality rate that is greater than 30% [1], low annual incidence of 1-2 cases per million people [2, 3], and largely unknown pathogenesis—TEN is identified as a cutaneous hypersensitivity reaction and is regarded as the most severe of its type, capable of affecting more than 30% of the total body surface area (TBSA)
Due to the large area of involvement, the patient was managed in the burn unit by a multidisciplinary team with strict isolation including isolated room and barrier isolations, daily wound dressing with local Bactroban application, IV ceftriaxone stopped after negative blood culture, and good hydration (3 times the maintenance; maintenance was 1400 ml/day)
Summary
Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction to drugs or their metabolites with multisystem involvement. With a high mortality rate that is greater than 30% [1], low annual incidence of 1-2 cases per million people [2, 3], and largely unknown pathogenesis—TEN is identified as a cutaneous hypersensitivity reaction and is regarded as the most severe of its type, capable of affecting more than 30% of the total body surface area (TBSA). The largest trial to date showed a decreased mortality rate from 51.4% to 29.8% after transfer to a burn unit within 7 days [5]. Our suggested method of approach is distinguished by the application of both burn care and IVIG, which would be working in tandem on the premises of combatting and treating TEN. We found that this method decreases mortality in other cases that used the same approach
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