Two cases of toxic epidermal necrolysis treated with plasma exchange
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概要
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Drug-induced toxic epidermal necrolysis (TEN) is a rare, but severe disease, resembling widespread second-degree burns. We report on two cases of TEN. Case 1: A 53-year-old woman presented with a skin rash in the clinical course of severe acute pancreatitis. She was diagnosed as having TEN, affecting 90% of her body surface area (BSA). She was transferred to our ICU, presenting with respiratory and renal dysfunction, and severe sepsis. She was treated in a similar manner as treatment for severe burns and underwent 6 plasma exchange series. However, the infection became uncontrollable and the skin lesion showed no improvement. She died of multiple organ failure (MOF) on the 61st ICU day. Case 2: A 34-year-old man was admitted to our ICU with a diagnosis of TEN, affecting 40% of his BSA. We performed 3 plasma exchange series. The skin lesion and general condition gradually improved, and he was transferred to a general ward on the 17th ICU day. Current evidence suggests that keratinocytes is died through apoptosis in TEN and that Fas-Fas ligand interactions are involved in TEN pathophysiology. We studied the serum soluble Fas ligand (sFasL), and evaluated the time course of sFasL concentrations in these 2 cases. Serum concentrations of sFasL in Case 1 were sustained at a high level, whereas those in Case 2 gradually decreased. The sFasL concentration may be related to the severity and clinical course of TEN.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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