David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California.
Department of Medicine, Division of Dermatology, University of California Los Angeles, Los Angeles, California.
Dermatol Ther. 2018 Sep;31(5):e12684. doi: 10.1111/dth.12684. Epub 2018 Sep 2.
Toxic shock syndrome (TSS) can sometimes mimic Steven Johnsons syndrome/toxic epidermal necrolysis (SJS/TEN). Tumor necrosis factor (TNF) alpha is thought to play a role in the pathogenesis of both TSS and SJS/TEN. Etanercept, a TNF-alpha inhibitor has been recently shown to treat and decrease mortality of SJS/TEN. We report a 51-year-old female with history of SJS presenting with painful skin and bullae 2 days following cystoscopy with botulinum toxin injection into the bladder. Due to initial concern for SJS/TEN, the patient was treated with 50 mg of subcutaneous etanercept. Punch biopsies were not consistent with SJS, and the patient fulfilled five out of five criteria for a confirmed case of TSS. The patient ultimately had a favorable outcome despite etanercept treatment. Ultimately, TNF-alpha antagonists are an emerging therapy to treat SJS/TEN, and are unlikely to worsen TSS prognosis. Given that etanercept can be used to successfully treat SJS/TEN and TNF-alpha levels are elevated in TSS, if a dermatologist chooses to treat TEN with etanercept, consideration of TSS on the differential should not necessarily exclude etanercept as a reasonable treatment option.
中毒性休克综合征（TSS）有时可能类似于史蒂文·约翰逊综合征/中毒性表皮坏死松解症（SJS/TEN）。肿瘤坏死因子（TNF）α被认为在 TSS 和 SJS/TEN 的发病机制中起作用。依那西普是一种 TNF-α抑制剂，最近已被证明可治疗 SJS/TEN 并降低死亡率。我们报告了一位 51 岁的女性患者，有 SJS 病史，在接受膀胱内注射肉毒杆菌毒素的膀胱镜检查后 2 天出现疼痛性皮肤和水疱。由于最初担心 SJS/TEN，给患者使用了 50mg 的皮下依那西普。皮肤活检与 SJS 不一致，且患者符合 TSS 确诊病例的五项标准中的五项。尽管接受了依那西普治疗，患者最终仍有良好的预后。最终，TNF-α拮抗剂是治疗 SJS/TEN 的一种新兴疗法，不太可能恶化 TSS 的预后。鉴于依那西普可成功治疗 SJS/TEN，且 TSS 中 TNF-α 水平升高，如果皮肤科医生选择用依那西普治疗 TEN，则在鉴别诊断中考虑 TSS 不应排除依那西普作为合理的治疗选择。
