Wani Abdul Majid, Hussain Waleed Mohd, Fatani Mohamad Ibrahim, Ali Khaled Shawkat, Khoujah Amer Mohd, Akhtar Mubeena, Maimani Ghassan Adnan Al, Raja Sadeya Hanif, Basraheel Ashraf, Fareed Khurram
Hera General Hospital, Emergency Medicine, 4a/201, Hera General Hospital, Makkah, Western, 21955, Saudi Arabia.
BMJ Case Rep. 2009;2009. doi: 10.1136/bcr.10.2009.2392. Epub 2009 Dec 30.
Toxic epidermal necrolysis (TEN) is a rare but life threatening skin disease that is most commonly drug induced. The exact pathogenesis of TEN is still unknown and many drugs, including prednisolone, cyclosporin and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of IVIG in particular is controversial. Recently, the US Food and Drug Administration (FDA) has made a labelling change to the drug information for carbamazepine. Owing to recent data implicating the HLA allele B*1502 as a marker for carbamazepine induced Stevens-Johnson syndrome and TEN in Han Chinese, the FDA recommends genotyping all Asians for the allele. We present an interesting case of carbamazepine induced TEN which was confused with oral thrush, had no skin lesions on presentation, and had an excellent response to a 5 day course of methylprednisolone and high dose IVIG in combination.
中毒性表皮坏死松解症（TEN）是一种罕见但危及生命的皮肤病，最常见由药物引起。TEN的确切发病机制仍不清楚，许多药物，包括泼尼松龙、环孢素和静脉注射免疫球蛋白（IVIG），都曾被用于试图阻止疾病进程。尤其是IVIG的使用存在争议。最近，美国食品药品监督管理局（FDA）对卡马西平的药品信息进行了标签更改。由于最近的数据表明HLA等位基因B*1502是卡马西平诱发的史蒂文斯-约翰逊综合征和TEN在汉族人群中的一个标志物，FDA建议对所有亚洲人进行该等位基因的基因分型。我们报告了一例有趣的卡马西平诱发的TEN病例，该病例最初被误诊为口腔鹅口疮，就诊时无皮肤病变，经5天的甲泼尼龙和高剂量IVIG联合治疗后反应良好。
