Tan You-Wen, Liu Li-Ping, Zhang Kai
Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang 212003, Jiangsu Province, China.
World J Clin Cases. 2024 Mar 6;12(7):1371-1377. doi: 10.12998/wjcc.v12.i7.1371.
Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) are very serious skin allergies, with an etiology related to infections and medication. Since the coronavirus disease 2019 (COVID-19) pandemic, severe acute respiratory syndrome coronavirus-2 has also been considered to cause SJS/TEN.
We report the case of a woman in her thirties who took acetaminophen after contracting COVID-19. After 3 d of fever relief, she experienced high fever and presented with SJS/TEN symptoms, accompanied by intrahepatic cholestasis. Three days of corticosteroid treatment did not alleviate the skin damage; therefore, double plasma molecular adsorption system (DPMAS) therapy was initiated, with treatment intervals of 48 h. Her skin symptoms improved gradually and were resolved after seven DPMAS treatments.
DPMAS therapy is beneficial for abrogating SJS/TEN because plasma adsorption and perfusion techniques reduce the inflammatory mediators (, tumor necrosis factor-alpha and interleukin-10 and-12) speculated to be involved in the pathology of the skin conditions.
史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症(SJS/TEN)是非常严重的皮肤过敏反应,其病因与感染和药物有关。自2019冠状病毒病(COVID-19)大流行以来,严重急性呼吸综合征冠状病毒2也被认为可导致SJS/TEN。
我们报告了一名三十多岁女性的病例,她在感染COVID-19后服用了对乙酰氨基酚。在发热缓解3天后,她再次出现高热,并表现出SJS/TEN症状,伴有肝内胆汁淤积。三天的皮质类固醇治疗未能减轻皮肤损伤;因此,启动了双重血浆分子吸附系统(DPMAS)治疗,治疗间隔为48小时。她的皮肤症状逐渐改善,经过七次DPMAS治疗后症状消失。
DPMAS治疗对消除SJS/TEN有益,因为血浆吸附和灌注技术可减少推测与皮肤疾病病理相关的炎症介质(如肿瘤坏死因子-α和白细胞介素-10及-12)。