Toxic epidermal necrolysis. Granulocytic leukopenia as a prognostic indicator

Abstract

Drug-induced toxic epidermal necrolysis is a disease of severe morbidity and high mortality. In the ten cases reported herein, therapeutic measures, including antibiotics, closed mechanical ventilation, maintenance of fluid and electrolyte balance, and management in special burn-care units, failed to alter a poor prognosis. The administration of corticosteroids was of no apparent benefit and may have been detrimental. Young age seemed to have a favorable influence on survival. There developed a pattern of leukopenia due to severe granulocytopenia that proved to be of prognostic importance. Persistence of the granulocytopenia portended a fatal outcome, whereas recovery of the granulocyte count to normal indicated, overall, a more favorable trend. The cause of the granulocytopenia could not be determined.

Peripheral Blood Mononuclear Cells Cytokine Profile in a Patient with Toxic Epidermal Necrolysis Triggered by Lamotrigine and COVID-19: A Case Study

“…The presence of neutropenia was indicative of a poor prognosis, whereas the recovery of the granulocyte count to normal levels suggests a more favorable outcome [ 19 ]. Nevertheless, the underlying cause of granulocytopenia remained undetermined [ 20 ], consistently with the overcome of our patient.…”

Hematological abnormalities and the use of granulocyte‐colony‐stimulating factor in patients with Stevens–Johnson syndrome and toxic epidermal necrolysis

“…A recent retrospective case series 9 of 21 patients with TEN reported four deaths out of the six patients with neutropenia. Westly and Wechsler 14 described 10 patients with TEN who had neutropenia that followed a trend similar to our study. They noted a persistent or worsening neutropenia in five patients who died from TEN.…”

Toxic Epidermal Necrolysis Due to Antieptic Therapy in an 8‐year‐old Boy

“…Only recently it has been reported that of 10 patients with TEN, only two children and one teenager have survived. In contrast to our patient, all of them had corneal scarring and mottled cutaneous hyperpigmentation, and one also had eruptive nevi of the neck and the trunk (13). The second factor was our patient's leukocyte pattern during the course of the disease.…”

“…In our patient, TEN developed two weeks after the first administration of DPH, which is known as an etiologic factor (12,13,15). A rash had also appeared earlier after the administration of primidone.…”