Toxic epidermal necrolysis in a 4‐year‐old boy successfully treated with plasma exchange in combination with methylprednisolone and i.v. immunoglobulin

Aihara, Yukoh; Oyama, Yoshitaka; Ichikawa, Kazushi; Takeshita, Saoko; Takahashi, Yukitoshi; Kambara, Takeshi; Aihara, Michiko

doi:10.1111/j.1346-8138.2012.01534.x

Cited by 7 publications

(6 citation statements)

References 3 publications

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“…3,7–9,15,16 Plasmapheresis has been reported as efficacious in association to methylprednisone and intravenous immunoglobulins in a pediatric case. 15 However, to the best of our knowledge, there are no reported experiences in the literature regarding the association of CsA and plasmapheresis. What’s more, there are only 6 reported cases of children with TEN treated with plasmapheresis in the international literature.…”

Section: Discussionmentioning

confidence: 99%

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Management of Toxic Epidermal Necrolysis with Plasmapheresis and Cyclosporine A: Our 10 Years’ Experience

Giudice

Maggio

Bufano

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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Background:The management of toxic epidermal necrolysis (TEN) is controversial and there is no uniform strategy.Objective:To share our 10 years’ experience in treating severe TEN with a novel protocol based on the association of cyclosporine A and plasmapheresis.Methods:In this case series, we retrospectively collected and assessed the 12 cases of severe TEN treated from 2005 to 2015 at the Burn Unit of the University of Bari Policlinico hospital.Results:Average body surface area was 77; average SCORETEN was 4.3. The 12 patients had been treated with culprit drug withdrawal, systemic corticosteroids, and/or cyclosporine A with no response. The protocol was successfully administered in all 12 cases. Average time to response from protocol start was 4.9 days. Average time to remission from protocol start was 22 days; average hospital stay at our unit was 24.8 days. Four patients developed severe complications; 1 patient died. No complications linked to the protocol therapeutic measures were observed. The relatively small number of cases given the rarity of the condition is a limitation of this report.Conclusion:Our protocol based on the association of cyclosporine A and plasmapheresis is safe and efficacious in treating severe TEN.

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Section: Discussionmentioning

confidence: 99%

“…What’s more, there are only 6 reported cases of children with TEN treated with plasmapheresis in the international literature. 3,15,16 Among these, none employs the SCORETEN system to standardize clinical severity and prognosis.…”

Section: Discussionmentioning

confidence: 99%

Management of Toxic Epidermal Necrolysis with Plasmapheresis and Cyclosporine A: Our 10 Years’ Experience

Giudice

Maggio

Bufano

et al. 2017

Plastic and Reconstructive Surgery - Global Open

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“…Because the patient showed clinical features of renal failure after admission to the PICU, the institution of therapy with cyclosporines was contraindicated due to its potential nephrotoxicity. Based on the reports demonstrating effective use of plasmapheresis [14,17] in SJS, the decision was made to apply this therapy, despite the late stage of disease. After only two days, remarkable improvement of local and general condition was achieved.…”

Section: Discussionmentioning

confidence: 99%

“…When the treatment fails, immunosuppressive therapy with cyclosporine A [9,10] or infliximab [11,12] can be considered. An alternative method enabling the elimination of toxic and immunological factors is plasmapheresis (PP) [13][14][15].…”

mentioning

confidence: 99%

Zastosowanie plazmaferezy w zespole toksycznej nekrolizy naskórka u 4-letniego chłopca

Hinc-Kasprzyk¹,

Polak-Krzemińska²,

Głowacka³

et al. 2015

Anaesthesiol Intensive Ther

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Background: Toxic epidermal necrosis (TEN) is a severe and life-threatening syndrome manifesting as extensive necrosis of the epidermis and mucous membranes accompanied by systemic symptoms. The causative factor is exposure to drugs, such as sulphonamides, antiepileptic preparations, non-steroidal anti-inflammatory drugs and paracetamol. The mechanism leading to the development of lesions is unknown and there is no uniform strategy of management. Case report: A 4-year-old boy was admitted with late-stage TEN; he was additionally affected by partial atrophy of the corpus callosum, mental retardation and drug-resistant epilepsy. Three weeks before the first symptoms developed, antiepileptic treatment was widened with lamotrigine, which seems to be the causative factor of TEN. Since general and topical pharmacological therapy failed, plasmapheresis was applied and already after 2 cycles, the progression of lesions was inhibited and circulation was gradually stabilized. Conclusions: The use of plasmapheresis in a child with TEN can result in substantial improvement of the general and local condition. The case presented clearly indicates that standards of management of children with suspected or developed TEN should be urgently instituted.

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“…Finally, plasmapheresis has also been applied to treat SJS/TEN and has resulted in good outcomes in both adults and children [11,20,43,44]. Generally, it is used after pharmacological therapy (IVIGs and corticosteroids) when lesions progress or when there is no improvement in the patient's condition.…”

Section: Treatmentmentioning

confidence: 99%

Zespół toksycznej nekrolizy naskórka

Hinc-Kasprzyk¹,

Polak-Krzemińska²,

Ożóg-Zabolska³

2015

Anaesthesiol Intensive Ther

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Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), also known as Lyell's syndrome, are rare, life-threatening diseases that are characterised by extensive epidermal detachment, erosion of mucous membranes and severe systemic symptoms. In the majority of cases, the development of symptoms can be attributed to the use of drugs; therefore, the disease pathology is thought to be caused by a severe adverse reaction to drugs. The high mortality rate results primarily from the development of complications in the form of systemic infections and multiple organ failure. TEN and SJS affect all age groups, including newborns, infants and older children. The rarity of these syndromes has not permitted large, randomised studies, which has resulted in numerous difficulties in their diagnosis and management. Because the pathogenesis has not yet been established, the management and systemic treatment of these syndromes have not been standardised. The efficacy of the treatment options suggested has not been confirmed by clinical studies involving suitably large groups of patients, especially children.

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Toxic epidermal necrolysis in a 4‐year‐old boy successfully treated with plasma exchange in combination with methylprednisolone and i.v. immunoglobulin

Cited by 7 publications

References 3 publications

Management of Toxic Epidermal Necrolysis with Plasmapheresis and Cyclosporine A: Our 10 Years’ Experience

Management of Toxic Epidermal Necrolysis with Plasmapheresis and Cyclosporine A: Our 10 Years’ Experience

Zastosowanie plazmaferezy w zespole toksycznej nekrolizy naskórka u 4-letniego chłopca

Zespół toksycznej nekrolizy naskórka

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