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2017 ; 3
(1
): 29-33
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Toxic Epidermal Necrolysis - A Case Report
#MMPMID29967868
St?tescu L
; Constantin M
; Morariu HS
; Solov?stru LG
J Crit Care Med (Targu Mures)
2017[Feb]; 3
(1
): 29-33
PMID29967868
show ga
Toxic epidermal necrolysis (TEN) is an acute, life-threatening muco-cutaneous
disease, often induced by drugs. It is characterized by muco-cutaneous
erythematous and purpuric lesions, flaccid blisters which erupt, causing large
areas of denudation. The condition can involve the genitourinary, pulmonary and,
gastrointestinal systems. Because of the associated high mortality rate early
diagnosis and treatment are mandatory. This article presents the case of a
sixty-six years old male patient, known to have cirrhosis, chronic kidney
failure, and diabetes mellitus. His current treatment included haemodialysis. He
was hospitalized as an emergency to the Dermatology Department for
erythemato-violaceous, purpuric patches and papules, with acral disposition,
associated with rapidly spreading erosions of the oral, nasal and genital mucosa
and the emergence of flaccid blisters which erupted quickly leaving large areas
of denudation. Based on the clinical examination and laboratory investigations
the patient was diagnosed with TEN, secondary to carbamazepine intake for
encephalopathic phenomena. The continuous alteration in both kidney and liver
function and electrolyte imbalance, required him to be transferred to the
intensive care unit. Following pulse therapy with systemic corticosteroids,
hydro-electrolytic re-equilibration, topical corticosteroid and antibiotics,
there was a favourable resolution of TEN. The case is of interest due to possible
life-threatening cutaneous complications, including sepsis and significant fluid
loss, in a patient with associated severe systemic pathology, highlighting the
importance of early recognition of TEN, and the role of a multidisciplinary team
in providing suitable treatment.
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