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2009, Number 2

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Acta Pediatr Mex 2009; 30 (2)

Toxic epidermal necrolysis treated with immunoglobulin. Report of a case

Sánchez-Michaca VJ, Sánchez-Torres R, Espinosa- Dzib MP, Jiménez-Urueta PS, García-Galavis JL

Language: Spanish
References: 35
Page: 104-108
PDF size: 168.30 Kb.


ABSTRACT

Introduction: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are the most severe cutaneous reactions that occur in children. Drugs are the predominant inciting agent in both entities. Off-label use of human intravenous immunoglobulin (IVIG) has been reported in a number of autoimmune and cell-mediated blistering disorders of the skin, including severe cutaneous drug reactions. We report our experience in one child in whom IVIG was used successfully for TEN. We reviewed the results mentioned in the literature using IVIG for SJS/TEN in pediatric patients
Case report: A 5-year 6-month old girl was prescribed trimetroprim-sulfametoxasol. Two days later, she was hospitalized with a 4-day history of high fever, dysphagia, photophobia and a 2-day history of a skin eruption which began on the face and progressed to the upper trunk and extremities. Physical examination revealed a pale acutely ill child, with a temperature of 101°F. A few erythematous macules were present on the upper back. Vesico-bullae were scattered over the face, and were especially prominent in the trunk and the extremities. A few intact vesico-bullae were also present on her neck. Mucous membrane examination showed bilateral nonpurulent conjunctivitis; hemorrhagic crusts of the lips, and superfi cial erosions of the tongue, hard palate, and genital labia. The clinical diagnosis of TEN was made. Intravenous immunoglobulin (IVIG) was begun at l.0 g/kg/dose/daily. After the 2 daily dose of IVIG the patient was afebrile and her cutaneous disease was in remission.
Discussion: IVIG seems to be a useful and safe therapy for children with severe cutaneous drug reactions. Well-controlled, prospective, multicenter clinical trials are needed to determine optimal dosing guidelines and to compare the effi cacy and safety of IVIG with other potentially effective modalities


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