Abstract
BackgroundToxic epidermal necrolysis (TEN) is a rare life-threatening condition almost exclusively attributed to drugs. The main etiologic factors for TEN are sulphonamides, anticonvulsants, and antibiotics; however, there are no published reports of warfarin causing TEN.Case presentationWe present the case of a 3-year-old patient who developed TEN while receiving treatment for Henoch–Schönlein purpura nephritis (HSPN). With multiple-drug therapy comprising prednisolone, mizoribine, dipyridamole, and warfarin, it is difficult to detect which drug is the causative agent. While in most cases, diagnosis of the causative drug is based on clinical history without a lymphocyte transformation test (LTT), we performed the test three times and identified the causative drug as warfarin at the late phase. We continued HSPN treatment without warfarin, and results showed good renal function without life-threatening complications.ConclusionTo our knowledge, this is the first report about TEN caused by warfarin. Repeated LTTs could be useful for identifying TEN-causative drugs even in the late phase.
Highlights
Toxic epidermal necrolysis (TEN) is a rare life-threatening condition almost exclusively attributed to drugs
Repeated lymphocyte transformation test (LTT) could be useful for identifying TEN-causative drugs even in the late phase
In Drug-induced hypersensitivity syndrome (DIHS)/Drug rash and eosinophilia with systemic symptoms (DRESS) patients, the regulatory T cells dramatically increase in frequency in the acute stage, and return to normal upon recovery; this change was observed in patients with DIHS but not in TEN drug reactions, indicating that an increase in regulatory T cells may contribute to negative LTT results at the acute stage but positive results at the late phase [3]
Summary
This is the first report of warfarininduced TEN. Identification of the causative drug is based on the clinical history without LTT (Table 1), we performed the test three times and detected the causative drug during the late phase. When HSPN therapy was started without warfarin, proteinuria disappeared and renal function was not compromised. Repeated LTTs could be useful for detecting the causative drug even in the late phase
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