Toxic epidermal necrolysis in hepatitis A infection with acute-on-chronic liver failure: Case report and literature review

Abstract

Toxic epidermal necrolysis (TEN) and Stevens–Johnson syndrome (SJS) are acute inflammatory skin adverse reactions characterized by epidermal exfoliation and multi-site mucositis and are considered medical emergencies. The risk factors for SJS/TEN include immune disorders, malignancy, and genetic susceptibility. In most cases, medication is considered to be the leading cause of TEN. In addition, several studies suggest that infections, such as the herpes simplex virus, human immunodeficiency virus (HIV), Mycoplasma pneumoniae, streptococcus, and meningococcus infections, can trigger the occurrence of SJS/TEN. In this rare case, we share our experience managing TEN in a hepatitis A virus infection with an acute-on-chronic liver failure patient. A 38-year-old man was infected with hepatitis A virus on the basis of liver cirrhosis and progressed to acute-on-chronic liver failure. As the infection progressed, the target-like skin lesions accompanied by mucosal involvement worsened. The condition of the patient progressively worsened with a severe generalized rash, bullae, and epidermal detachment accompanied by severe erosive mucosal lesions. His skin detachment area gradually involved 30% of the body surface area (BSA), and the disease progressed to TEN. The intravenous infusion of corticosteroids alleviated the patient's hypersensitivity, and the patient obtained lasting remission without severe adverse reactions and complications.

Toxic epidermal necrolysis caused by viral hepatitis A: a case report and literature review

“…In 1989, Werblowsky-Constantini (39) first reported the case of a 35-year-old man with fever for 3 weeks, 50% skin lesions, hyperbilirubinemia, and high ALP levels, similar to our patient's liver function. Zang et al (40) also reported a case of TEN related to HAV infection in a 38-year-old male with cirrhosis and preexisting liver failure. The patient developed skin lesions 15 days after the TBIL reached its peak, accompanied by fever with a maximum body temperature of 39.0°C, and sustained remission was achieved with intravenous corticosteroids.…”

Stevens-Johnson syndrome/toxic epidermal necrolysis associated with natural thyroid medication

“…Stevens-Johnson syndrome/TEN is often triggered by medications but may also be secondary to infections such as pneumonia, herpes virus, and hepatitis [2]. It occurs at higher incidence in patients with human immunodeficiency virus and can have mimics such as in SJS-like acute graft-versus-host disease [3].…”

Phenytoin-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis Overlap in Focus: A Case Report

“…The mean adjusted mortality rates were 4.8% for SJS, 19.4% for SJS/TEN, and 14.8% for TEN [2]. Some of the identified causes of SJS/TEN include medications, mycoplasma pneumonia, herpes, hepatitis A, and vaccination [3]. The primary cause of this life-threatening disorder is drugs, with common examples being sulfonamides and anti-epileptic drugs such as phenytoin, carbamazepine, lamotrigine, phenobarbital, and allopurinol, as well as non-steroidal anti-inflammatory drugs like piroxicam, diclofenac, and nevirapine [4].…”