Toxic Epidermal Necrolysis with Extensive Mucosal Erosions of the Gastrointestinal and Respiratory Tracts

Abstract

Toxic epidermal necrolysis with epidermal shedding over almost the entire body occurred in a patient with classical rheumatoid arthritis treated with sulindac, penicillamine and a combination analgesic containing paracetamol and chlormezanone. Erosions in the lower respiratory tract and the intestine contributed to a lethal outcome of the disease and showed a microscopical picture similar to that of the skin involved. The histopathological picture of these extracutaneous lesions have been only briefly reported previously.

Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study

“…Pulmonary complications have been occasionally reported in the course of TEN in a few isolated cases [11][12][13][14]. However, to our knowledge, this study is the first prospective evaluation of respiratory tract involvement in a large series of patients with TEN.…”

“…In one case of TEN with multiple organ failure described in the literature, necrosis of the alveolar walls was reported but autopsy was performed after a long period of assisted ventilation and septic complications, raising the question of the specificity of these pathologic findings [13]. Other pulmonary manifestations related to bronchial mucosal involvement have been described elsewhere, including mild hemoptysis [12] or expectoration of bronchial mucosal casts, which seems highly suggestive of bronchial mucosal involvement [14].…”

“…However, it is a life-threatening disease, fatal in 30 % of cases, and death is mainly related to sepsis or visceral involvement such as gastrointestinal or pulmonary complications [9,10]. Pulmonary manifestations have been poorly studied but appear to be heterogeneous, including specific bronchial mucosal necrosis, pulmonary edema, and infectious pneumonitis, as described in a few isolated case reports or rare postmortem studies [11][12][13][14][15]. The aim of the present study was therefore to evaluate the incidence of pulmonary manifestations in TEN, to define their clinical characteristics, and to determine their prognosis in a large prospective series.…”

Toxisch epidermale Nekrolyse

“…Dabei ist die Sepsis der hauptsächliche Letalitätsfaktor [13,18,20,34,35]. Angaben zum klinischen Verlauf großflächiger Epidermolysen, einhergehend mit ausgedehnten Läsionen des Endothels, finden sich in der Literatur nur selten und stützen sich auf Einzelfalldarstellungen [2,7,8,27,31,33,36,37].…”

“…Der Häufigkeit nach werden Konjunktiven, Oropharynx, Genitale, Urethra und Anus in sehr variablem Ausmaß erfasst [5,22,34,35,36]. Ausgedehnte Störungen der Funktion des Gastrointestinal-und Respirationstraktes finden sich vergleichsweise selten [2,8,27,31,33,35,36].…”