Nishita Yoshihiro, Taga Masatoshi, Arakawa Nozomi, Ishida Tomoki, Ochiai Sawako, Ono Hiroto, Taga Fumiaki, Masauji Togen
Department of Pharmacy, Kanazawa Medical University Hospital, 1-1 Daigaku, Uchinada-Cho, Kahoku-Gun, Ishikawa, 920-0293, Japan.
Department of Dermatology, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Cho, Kahoku-Gun, Ishikawa, 920-0293, Japan.
J Pharm Health Care Sci. 2025 Jan 28;11(1):6. doi: 10.1186/s40780-024-00405-2.
Toxic epidermal necrolysis (TEN), a severe cutaneous hypersensitivity reaction induced particularly by drugs, is diagnosed when there is a fever of ≥ 38 °C, mucocutaneous symptoms, a rash with multiple erythema, and skin peeling of ≥ 30% of the body surface area. The mortality rate of TEN is high, and thrombocytopenia during treatment can lead to severe outcomes. Intravenous immunoglobulin (IVIg) is used when steroids are ineffective in TEN and may improve mortality; however, thrombocytopenia is a rare adverse event associated with IVIg use. We report the case of thrombocytopenia during IVIg therapy for TEN. We also reviewed previous reports to learn more about the clinical course and mechanism of IVIg-induced thrombocytopenia.
An 83-year-old man with end-stage renal failure on hemodialysis was diagnosed with TEN. After an inadequate response to pulse methylprednisolone therapy, IVIg (400 mg/kg/day) was administered for 5 days. He developed thrombocytopenia after IVIg administration, leading to the diagnosis of thrombocytopenia due to IVIg after excluding other diseases. The platelet count began to increase approximately 10 days after IVIg administration.
When IVIg is administered for TEN, the risk of thrombocytopenia should be recognized and the platelet count should be carefully monitored.
中毒性表皮坏死松解症（TEN）是一种严重的皮肤超敏反应，尤其由药物引起，当体温≥38°C、出现黏膜皮肤症状、有多处红斑皮疹且皮肤剥脱面积≥体表面积的30%时可诊断。TEN的死亡率很高，治疗期间的血小板减少可导致严重后果。当类固醇对TEN无效时可使用静脉注射免疫球蛋白（IVIg），其可能改善死亡率；然而，血小板减少是与使用IVIg相关的罕见不良事件。我们报告1例TEN患者在IVIg治疗期间出现血小板减少的病例。我们还回顾了既往报告，以进一步了解IVIg诱导的血小板减少的临床过程和机制。
一名83岁接受血液透析的终末期肾衰竭男性被诊断为TEN。在对甲泼尼龙冲击疗法反应不佳后，给予IVIg（400mg/kg/天）治疗5天。他在IVIg给药后出现血小板减少，在排除其他疾病后诊断为IVIg所致血小板减少。血小板计数在IVIg给药后约10天开始上升。
在使用IVIg治疗TEN时，应认识到血小板减少的风险，并应仔细监测血小板计数。
