A Case of Toxic Epidermal Necrolysis (TEN) Treated by Plasmapheresis

Abstract

Toxic epidermal necrolysis (TEN) is an uncommon but life-threatening condition. It is characterized by the rapidly progressive onset of widespread epidermal necrosis, resulting in flaccid bullae with epidermal sloughing and frequent involvement of the mucous membrane. Currently, there is no clinically proven effective therapeutic modality for TEN. There have been several uncontrolled studies reporting beneficial clinical efficacy of plasmapheresis in patients with TEN. We report a case of severe TEN which was successfully improved by plasmapheresis treatment. A 26-year-old male patient was admitted due to severe myalgia and sore mouth at 8 days after medication with ofloxacin and loxoprofen for 3 days after eye surgery. After admission, a high spiking fever and erythematous skin rashes on both palm and sole developed in this patient and his skin lesions subsequently progressed to generalized bullous skin lesions covering the whole body area with oropharyngeal ulceration and conjunctivitis. The patient was diagnosed with TEN and administered intravenous immunoglobulin (IVIG) for 3 days, but he did not improved. Then he received plasmapheresis treatment for 3 days. After the plasmapheresis treatment, the progression of epidermal detachment of the skin was stopped and no new lesions developed. His bullous skin lesions progressively resolved.