Management of a Case of Toxic Epidermal Necrolysis in Intensive Care Unit

IntroductIonToxic epidermal necrolysis syndrome (TENS) is a life-threatening cutaneous condition presenting with features of epidermal loss, which is associated with extracutaneous and systemic manifestations.It is commonly precipitated by intake of drugs or changes in medications.However, other causes, such as bacterial and viral infections, have also been described.The most common drugs implicated in Stevens-Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) development include phenobarbital, phenytoin, carbamazepine, lamotrigine, nonsteroidal antiinflammatory drugs, allopurinol cotrimoxazole, fluoroquinolones, albendazole, and fluconazole. 1,2Early recognition of TENS and stopping the causative agent is the cornerstone of treatment. 3Toxic epidermal necrolysis syndrome is seen in around 0.4-1.2people per million population per year and carries a mortality of 20-40%. 4t can be differentiated from SJS by the extent of the total body surface area (TBSA) affected.In TENS, >30% of TBSA is affected. 5The main line of treatment is immunosuppression with dexamethasone and cyclosporine. 6,7se PresentatIon A 42-year-old female with a preexisting seizure disorder presented to our setup.She was on long-term treatment with phenobarbitone, which was changed to phenytoin 2 weeks before symptom onset for unknown reasons.Ten days later, she developed an area of erythema on her back with itching, which spread to the entire trunk and upper and lower extremities over the next 72 hours.It involved 80% of the TBSA with symmetrical, erythematous exanthema and blisters over the trunk, extremities, and face (Figs 1A andB).The Nikolsky I-sign was positive.Her oral mucosa showed erosions with a white-colored coating.The patient had severely restricted mouth opening with edema.The patient also had conjunctival congestion and sloughing.The SCORTEN score (SCORe of Toxic Epidermal Necrolysis) was determined on admission.It is a prognostic score for TENS with one