Toxic Epidermal Necrolysis: A Case Report

Abstract

ÖzetSteven's Johnson Sendromu (SJS) ve toksik epidermal nekroliz (TEN), ciddi klinik tablolara ve mortaliteye sebep olabilen, deri ve mukozaların akut seyirli ve şiddetli reaksiyonlarıdır. Burada üst solunum yolu enfeksiyonu nedeniyle parasetamol, kodein fosfat ve klorfeniramin içeren tablet kullanımından sonra toksik epidermal nekroliz tablosu gelişen ve mortalite ile sonuçlanan olgu sunulmuştur. Çocuk hastalarda SJS ve TEN gibi ciddi klinik tablolara neden olabilecek durumlar göz önün-de bulundurulmalı, gereksiz ilaç kullanımından kaçınılmalıdır. Anahtar Kelimeler Steven-Johnson Sendromu; Toksik Epidermal Nekrolizis; İlaç Yan Etkileri AbstractStevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe, acute reactions of the skin and mucosa that can result in serious clinical outcomes and morbidity. We report a case of TEN resulting in mortality, following the use of tablets containing paracetamol, codeine phosphate, and chlorpheniramine for an upper respiratory tract infection. Conditions such as SJS and TEN that can lead to serious clinical outcomes should be considered in juvenile patients, and unnecessary drug use should be avoided.

British Association of Dermatologists' guidelines for the management of Stevens–Johnson syndrome/toxic epidermal necrolysis in children and young people, 2018

“…In adults, a delay in transfer to specialized care adversely affects the outcome, 1 and there is some evidence that longer times to referral increase mortality in children and young people. [37][38][39] Patients do not die of TEN but of complications arising from TEN; therefore, reducing these complications is paramount. High-risk children [including those with extensive epidermal loss (greater than 70%), high initial SCORTEN, likely medication cause, underlying malignancy or previous stem cell transplantation] need quicker transfer to specialized care.…”

“…In adults, a delay in transfer to specialized care adversely affects the outcome, and there is some evidence that longer times to referral increase mortality in children and young people . Patients do not die of TEN but of complications arising from TEN; therefore, reducing these complications is paramount.…”

A Case Report on Amoxicillin Induced Toxic Epidermal Necrolysis

“…Most frequent triggers are drugs such as antiepileptics, barbiturates, pyrazolones and sulphonamides [4] . Often it may result from drugs with long half-lives and/orcirculating active metabolites.No specific laboratory test is available to confirm the aetiological agent, a causal link is suggested when it occurs in first few weeks of medication therapy, usually between 1 to 3 weeks [3,5] .…”