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原位肝移植受者发生史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症:一例报告

Stevens-Johnson syndrome/toxic epidermal necrolysis in an orthotopic liver transplant recipient: a case report.

作者信息

Huang Chun-Sing, Strouphauer Emily, O'Mahony Christine, Galván Nhu T N, Cotton Ronald, Goss John, Rana Abbas

机构信息

Division of Abdominal Transplantation, Michael E. DeBakey Department of General Surgery, Baylor College of Medicine, Houston, TX, United States.

School of Medicine, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, United States.

出版信息

J Surg Case Rep. 2024 Jan 16;2024(1):rjad739. doi: 10.1093/jscr/rjad739. eCollection 2024 Jan.

Abstract

Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is a rare spectrum of acute, mucocutaneous drug reactions characterized by epidermal necrosis of the skin and mucous membranes with progressive multiorgan failure. Cutaneous presentation of SJS/TEN is similar to that of acute graft-versus-host disease, creating a diagnostic dilemma in solid-organ transplant recipients presenting with diffuse, erythematous eruptions, skin sloughing, and systemic sequelae, reflective of both diseases. This case report details a 48-year-old woman post-orthotopic liver transplantation (OLT) who developed a diffuse, painful, morbilliform rash with progressive desquamation, along with corresponding pathological analysis indicative of SJS/TEN. There are few documented reports of SJS/TEN in solid-organ transplant recipients, and this case illustrates successful intervention and resolution of SJS/TEN in an OLT recipient while managing intraabdominal sepsis and an episode of acute rejection. Despite its rarity, prompt diagnosis of SJS/TEN and the implementation of tailored therapeutic strategies are crucial in the care of solid-organ transplant recipients.

摘要

史蒂文斯-约翰逊综合征/中毒性表皮坏死松解症(SJS/TEN)是一种罕见的急性黏膜皮肤药物反应,其特征为皮肤和黏膜的表皮坏死,并伴有进行性多器官功能衰竭。SJS/TEN的皮肤表现与急性移植物抗宿主病相似,这给出现弥漫性红斑疹、皮肤脱落及全身后遗症的实体器官移植受者带来了诊断难题,因为这两种疾病都会出现这些症状。本病例报告详细介绍了一名48岁的原位肝移植(OLT)术后女性,她出现了弥漫性、疼痛性、麻疹样皮疹,并伴有进行性脱屑,同时相应的病理分析表明为SJS/TEN。实体器官移植受者中记录在案的SJS/TEN病例很少,本病例展示了在一名OLT受者中成功干预并解决SJS/TEN的同时,还处理了腹腔内感染和一次急性排斥反应。尽管SJS/TEN很罕见,但对实体器官移植受者的护理而言,及时诊断SJS/TEN并实施针对性的治疗策略至关重要。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b495/10795906/7dd696220611/rjad739f1.jpg

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