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Journal of Dermatology Research and Skin Care | Volume 2
May 14-15, 2018 | Montreal, Canada
Spring Dermatology &
Skin Care Expo Conference
T
oxic epidermal necrolysis (TEN) is severe cutaneous
hypersensitivity reaction characterized by necrosis of
epidermis and detachment of epidermis and dermis that usually
occurs as an idiosyncratic reaction to certain drugs. Steven-
Johnson syndrome (SJS) is condition when less than 10% of
the skin is affected, SJS/TEN overlap when affected skin covers
10%-30% and TEN when more than 30% of skin is affected. We
report the case of a patient admitted to our intensive care unit
(ICU) after the above-the-knee amputation who developed
toxic epidermal necrolysis. Before operation due to MRSA and
Citrobacter freundii infection of the leg wound meropenem at
3g/day with vancomycin at 2g/day intravenously were started.
Preoperative assessment revealed multiple confluent macular
erythema, and bullous detachment of the epidermis over face,
trunk and extremities, but predominantly on the chest and
back. Above knee amputation was performed two days later
in general anesthesia. After surgery patient was addmited to
ICU where skin lesions continued to progress and in the next
two days epidermal detachment progressed and macular
erythema and bullous skin lesions affected more than 50%
of the total body surface area. Given the rapid progression of
the oral erosions and desquamation on most of the patient’s
body surface area leaded us to probability of the diagnosis of
TEN. Since it was assumed that the antibiotics caused TEN, all
antibiotics were excluded from the therapy. Our therapy for
TEN included a combination of intravenous immunoglobulin
with gentle early debridement of necrotic skin areas followed
by wound coverage with synthetic cover (Aquacel Ag®). The
dressings were changed periodically following cleaning with
saline and gentle debridement of exfoliated epidermis. After
15 days of local therapy, almost full reepithelialization was
achieved. This case-report suggests that intensive wound
management together with intravenous immunoglobulinmight
be beneficial in the treatment of patients with TEN.
Speaker Biography
University of Zagreb, School of Medicine, Croatia 2005. – 2011. General Hospital
Zabok, Croatia 2011.-2012. – Internship Emergency Medicine, Department at County
Krapinsko zagorska, Croatia 2012. – 2014. University. Hospital Sveti Duh, Zagreb,
Croatia – Resident in Anaesthesiology, reanimatology and intensive care medicine
2014. University of Josip Juraj Strossmayer Osijek, School of Medicine, Croatia –
Postgraduate student in Anaesthesiology, reanimatology and intensive care medicine
10/2016. – 7/2017
e:
tino.klancir@gmail.comTino Klancir
Sveti Duh Clinical Hospital, Croatia
Antibiotic induced toxic epidermal necrolysis: A case report