Ayele Biniyam A, Ali Kemal, Mulatu Eliyas
Department of Neurology, School of Medicine, College of Health Sciences Addis Ababa University, Liberia Street, PO Box 6396, Addis Ababa, Ethiopia.
Department of Dermatovenereology, Addis Ababa University, Addis Ababa, Ethiopia.
Allergy Asthma Clin Immunol. 2021 Sep 8;17(1):88. doi: 10.1186/s13223-021-00589-4.
Toxic epidermal necrolysis (TEN)/Stevens-Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, T-cell mediated delayed type IV hypersensitivity reaction and universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS.
We report a 14-year-old asthmatic male patient admitted to a local hospital for an acute exacerbation of asthma, after he presented with shortness of breath, cough, and fever. He was treated with bronchodilator and antibiotics. On subsequent days, the patient developed new onset generalized tonic clonic seizure in the hospital for which he was started on phenobarbitone of 100 mg twice daily. Two weeks after initiation of phenobarbitone, the patient developed extensive blistering skin eruptions; which subsequently exfoliated unevenly. Associated with the hypersensitivity skin reaction, the patient reported low grade fever, sore throat, and dysphagia. The exfoliation also involved oral and conjunctival mucosa; with estimated 65% body surface area involvement. The laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days the patients' clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharged improved after ten days of intensive care unit.
In summary, the present case describes, a 14-years-old young child with history of asthma and seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the better prognosis observed in pediatric population with TEN.
中毒性表皮坏死松解症（TEN）/史蒂文斯-约翰逊综合征（SJS）是一种严重的、急性的、黏膜皮肤的、T细胞介导的迟发型IV型超敏反应，普遍与不同药物有关。已知苯巴比妥会引起良性模式的过敏反应；范围从轻度到中度皮疹，但不会引起如TEN/SJS等危及生命的反应。
我们报告一名14岁的哮喘男性患者，因哮喘急性加重入住当地医院，此前他出现呼吸急促、咳嗽和发热症状。他接受了支气管扩张剂和抗生素治疗。随后几天，该患者在医院出现新发全身性强直阵挛性发作，为此开始每日两次服用100毫克苯巴比妥。苯巴比妥开始服用两周后，患者出现广泛的水疱性皮肤疹；随后不均匀地脱落。与超敏皮肤反应相关，患者报告有低热、咽痛和吞咽困难。皮肤脱落还累及口腔和结膜黏膜；估计体表面积受累65%。实验室检查显示轻度白细胞增多、凝血酶原时间延长和白蛋白降低。停用苯巴比妥，换用氯硝西泮；患者接受补液、静脉抗生素治疗、每日两次伤口护理、止痛治疗和鼻胃管喂养。随后几天，患者的临床状况开始改善；皮肤病变也开始在大多数受影响的皮肤表面愈合和脱落，在重症监护病房治疗十天后，患者病情好转出院。
总之，本病例描述了一名14岁患有哮喘和癫痫病史的幼儿；在接触苯巴比妥后发生中毒性表皮坏死。本病例还突出了儿童TEN患者观察到的较好预后。
