Phenytoin-induced toxic epidermal necrolysis (TEN). Combined treatment with steroids and human intravenous immunoglobulin: Case report

Abstract

Background. Toxic epidermal necrolysis (TEN) is a severe systemic disease that affects the skin and mucosa, with a mortality rate above 30%. Pharmaceutical drugs are the main causal agents of this reaction, with most cases being largely associated with phenytoin. There is no generally accepted treatment for TEN. The administration of systemic corticosteroids combined with human intravenous immunoglobulin (IVIG) may be a possible adjuvant therapy. Case presentation. A 72-year-old patient who received phenytoin for four weeks as a prophylactic treatment after undergoing surgery to drain a chronic subdural hematoma developed TEN-compatible symptoms, which prompted treatment with methylprednisolone (1 g/day for 3 days) combined with IVIG (0.5 gr/kg/day for 5 days), with favorable response. Conclusion. Our patient’s response to the combination of corticosteroids and IVIG was favorable. However, due to the nature of this report, the function this combination of drugs has must be further researched.