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Ketoprofen/paracetamol Toxic epidermal necrolysis: case report

A 65-year-old woman developed two episodes of toxic epidermal necrolysis (TEN) one each during treatment with ketoprofen and paracetamol [routes, dosages, indications and durations of treatments to reactions onsets not stated]. The woman, who had a history of diabetes mellitus type I, psoriasis and hypertension, was hospitalised following the development of TEN due to ketoprofen (first episode) with SCORTEN score of 3 and 80% total body surface area affected. The woman received treatment with total plasma exchange [Prismaflex] and immune globulin [Flebogamma] for 5 days in the Burns ICU. Her wounds were dressed with Aquacel Ag. She was administered imipenem and amikacin because of Acinetobacter baumannii and Escherichia coli colonies in the wounds. While in hospital, she received a total number of five total plasma exchanges with 120 units of plasma [fresh frozen plasma]. Twelve months after the first episode, she again developed TEN (second episode). She was hospitalised with 90% total body surface area affected and a SCORTEN score of 3. The second episode of TEN was caused by paracetamol [acetaminophen]. Following hospitalisation, her skin was cleared from dead epithelium and dressings with Aquacel Ag were applied. Total plasma exchange was started along with immune globulin. The protocol of total plasma exchange and immune globulin was followed two times a day up to third day of stay. Total plasma exchange and immune globulin were performed once. During second day in the ICU, continuous venovenous haemodiafiltration (CVVHDF) with citrate anticoagulation was initiated. CVVHDF was undertaken for the following 4 days. On day 5 of admission, stabilisation of skin lesions was noted. Total six plasma exchanges were performed with 60 units of plasma. She was discharged with a planned control visit in the outpatient clinic. Local skin findings during discharge included superficial epidermis exfoliation of lower extremities and mild erythema of the upper chest and back. During follow-up, no sequelae was noted. Krajewski A, et al. Successful therapy of recurrent toxic epidermal necrolysis using total plasma exchange, continuous venovenous hemodiafiltration, and intravenous immunoglobulin-Case report. Dermatologic Therapy 33: No. 4, Jul 2020. Available from: URL: http://doi.org/10.1111/dth.13442

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Reactions 17 Oct 2020 No. 1826