Khan Allahdad, Ain Qura-Tul, Batool Arshia, Khalid Misbah, Antar Mohamed, Ali Muhammad Abdullah
Department of Medicine, Nishtar Medical University, Multan, Pakistan.
Department of Pediatrics, Nishtar Medical University, Multan, Pakistan.
Ann Med Surg (Lond). 2025 Jul 18;87(9):6061-6064. doi: 10.1097/MS9.0000000000003596. eCollection 2025 Sep.
Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous reaction characterized by extensive epidermal detachment and multi-organ involvement. It is most commonly triggered by drugs, including antibiotics such as cephalosporins. Although TEN predominantly affects adults and females, its occurrence in pediatric males is exceedingly rare. Here, we report a fatal case of cefuroxime-induced TEN in a 4-year-old child, emphasizing the importance of early diagnosis, appropriate drug withdrawal, and timely intervention.
A 4-year-old Pakistani boy presented with persistent high-grade fever, widespread skin desquamation, and mucosal involvement. One month prior, he was prescribed cefuroxime for suspected measles. Within days of initiating therapy, he developed progressive epidermal detachment (>30% of total body surface area), confirming TEN. Laboratory findings revealed anemia, thrombocytopenia, elevated liver enzymes, and markers of systemic inflammation. Despite immediate drug cessation and supportive management, including intravenous fluids, wound care, and mechanical ventilation, his condition deteriorated, leading to multi-organ failure and death.
Cephalosporin-induced TEN is exceptionally rare, particularly in pediatric patients. The pathogenesis involves oxidative stress and keratinocyte apoptosis mediated by TNF-alpha. Treatment primarily consists of supportive care, with emerging therapies such as intravenous immunoglobulin and TNF-alpha inhibitors showing promise. However, limited healthcare resources often hinder access to these interventions in low-income settings.
This case highlights the fatal potential of TEN, particularly when access to specialized care is limited. Early drug withdrawal and aggressive supportive care remain crucial for improving survival outcomes. Rational antibiotic prescribing is essential to prevent such adverse drug reactions.
中毒性表皮坏死松解症（TEN）是一种罕见的、危及生命的皮肤黏膜反应，其特征为广泛的表皮剥脱和多器官受累。它最常见的诱因是药物，包括头孢菌素类抗生素。虽然TEN主要影响成年人及女性，但在儿科男性中极为罕见。在此，我们报告一例4岁儿童因头孢呋辛诱发TEN的致死病例，强调早期诊断、及时停药及适时干预的重要性。
一名4岁巴基斯坦男孩出现持续高热、广泛皮肤脱屑及黏膜受累症状。一个月前，他因疑似麻疹被开具头孢呋辛。开始治疗数天内，他出现进行性表皮剥脱（超过体表面积的30%），确诊为TEN。实验室检查结果显示贫血、血小板减少、肝酶升高及全身炎症标志物升高。尽管立即停药并给予支持治疗，包括静脉输液、伤口护理及机械通气，但其病情仍恶化，导致多器官功能衰竭并死亡。
头孢菌素诱发的TEN极为罕见，尤其是在儿科患者中。其发病机制涉及由肿瘤坏死因子-α介导的氧化应激和角质形成细胞凋亡。治疗主要包括支持治疗，新兴疗法如静脉注射免疫球蛋白和肿瘤坏死因子-α抑制剂显示出前景。然而，在低收入地区，有限的医疗资源常常阻碍获得这些干预措施。
本病例凸显了TEN的致命风险，尤其是在获得专科护理受限的情况下。早期停药及积极的支持治疗对于改善生存结局仍然至关重要。合理使用抗生素对于预防此类药物不良反应至关重要。
