Ulcérations muqueuses persistantes: Une complication rare de nécrolyse épidermique toxique

Abstract

Sequels can be observed in toxic epidermal necrolysis. Persistence of mucosal ulcerations is not a classical complication of this disease. We describe two case reports of mucous membrane ulcerations (oral and genital) which have remained many months after the acute phase of toxic epidermal necrolysis.Case 1. A little girl, 9 years old, was referred for a chronic and painful ulceration of the vulva that had appeared 9 months earlier during a toxic epidermal necrolysis. She presented a clearly crircumscribed vestibular ulceration. The mucosal biopsy was refused by the family. The genital erosion persisted more than one year after the acute phase. Case 2. A 73 year-old man was referred for a persistent and clearly circumscribed lingual ulceration, 9 cm in diameter. This chronic ulceration had appeared 3 months earlier, during the acute phase of a toxic epidermal necrolysis. The skin biopsy specimen, with histologic and direct immunofluorescence analysis, did not disclose any specific anomalies. After a period of clinical observation, intralesional injections of corticosteroids were decided and ulceration progressively decreased in 13 months.Complications of toxic epidermal necrolysis mainly occur at the acute phase. The most well documented sequelae are ophthalmological lesions. The most frequent cutaneous sequelae are cutaneous pigmentary changes and nail dystrophy. We report two observations of persistent mucous membrane erosions many months after the acute phase of toxic epidermal necrolysis. The pathophysiology of this complication, is rarely described and still remains unclear.