Tunuguntla Mounika Nagarani, Chanti Pranathi, Kesani Tanishq, Yarapathineni Kusuma, Kukkadapu Prithvi
Internal Medicine, Guntur Medical College, Guntur, IND.
Internal Medicine, Osmania Medical College, Hyderabad, IND.
Cureus. 2023 Jul 29;15(7):e42654. doi: 10.7759/cureus.42654. eCollection 2023 Jul.
Toxic epidermal necrolysis (TEN) is a rare fatal mucocutaneous blistering disorder that can have varied underlying triggers. The percentage of body surface area (BSA) that is impacted by erosive blistering is what separates it from Steven Johnson syndrome (SJS), both of which have the same underlying pathogenesis and are thought to exist on a continuum of disease with TEN being the more serious of the two. Medications are the most frequent cause of TEN/SJS and typically cause disease in both adults and children within eight weeks; however, the median exposure window is four days to four weeks. Nonsteroidal anti-inflammatory drugs, allopurinol, anticonvulsants including lamotrigine, phenytoin, levetiracetam and carbamazepine, antimicrobial sulfonamides, and the antiviral nevirapine are examples of medications that frequently cause TEN/SJS. Here, we are reporting a case of phenytoin-induced TEN highlighting the patient's excellent response to immunomodulating treatment despite 100% involvement of the BSA.
中毒性表皮坏死松解症（TEN）是一种罕见的致命性皮肤黏膜水疱性疾病，其潜在诱因多种多样。侵蚀性水疱累及的体表面积（BSA）百分比是将其与史蒂文斯-约翰逊综合征（SJS）区分开来的依据，二者具有相同的潜在发病机制，且被认为处于疾病的连续谱上，TEN是其中更严重的一种。药物是TEN/SJS最常见的病因，通常在8周内导致成人和儿童发病；然而，中位暴露窗口期为4天至4周。非甾体抗炎药、别嘌醇、包括拉莫三嗪、苯妥英、左乙拉西坦和卡马西平在内的抗惊厥药、抗菌磺胺类药物以及抗病毒药物奈韦拉平都是经常导致TEN/SJS的药物例子。在此，我们报告一例苯妥英引起的TEN病例，突出显示了尽管患者体表面积100%受累，但对免疫调节治疗反应良好。
