DOI: http://dx.doi.org/10.18203/issn.2455-4529.IntJResDermatol20193122

Toxic epidermal necrolysis treated with filgrastim and dexamethasone

Nishant Choudhary, Nidhi Sharma, Sujata Sinha, Sudip Das

Abstract


We report a case of 22 year female with toxic epidermal necrolysis while on carbamazepine. One hospital outside treated her with steroids but she didn’t show any improvement and rather worsened. The patient reported to us with fluctuating blood pressure and dyselectrolytemia. Patient also developed neutropenia (3,200/mm3) and sepsis. Patient was treated with filgrastim and dexamethasone. Filgrastim was added because of neutropenia and earlier case reports suggesting it aid in faster healing. Patient made a complete recovery. 


Keywords


Toxic epidermal necrolysis, Filgrastim

Full Text:

PDF

References


Bastuji-Garin S, Rzany B, Stern RS, Shear NH, Naldi L, Roujeau JC. Clinical classification of cases of toxic epidermal necrolysis, Stevens Johnson Syndrome and erythema multiforme. Arch Dermatol 1993;129:92-6.

Sharma VK, Vatve M, Sawhney IMS, Kumar B. Clinical spectrum of drug rashes due to antiepileptics. J Assoc Physicians India. 1998;46:595-7.

Roujeau JC, Kelly JP, Naldi L, Rzany B, Stern RS, Anderson T, et al. Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis. N Engl J Med. 1995;333;1600-7.

Nanda A, Kaur S. Drug induced toxic epidermal necrolysis in developing countries. Arch Dermatol. 1990;126:5.

Guégan S, Bastuji-Garin S, Poszepczynska-Guigné E, Roujeau JC, Revuz J. Performance of the SCORTEN during the first five days of hospitalization to predict the prognosis of epidermal necrolysis. J Invest Dermatol. 2006;126:272-6.

Patterson R, Miller M, Kaplan M, Doan T, Brown J, Detjen P, et al. Effectiveness of early therapy with corticosteroids in Stevens-Johnson syndrome: Experience with 41 cases and a hypothesis regarding pathogenesis. Ann Allergy. 1994;73:27-34.

Fernando SL. The management of toxic epidermal necrolysis. Australas J Dermatol. 2012;53:165-71.

Yang Y, Xu J, Li F, Zhu X. Combination therapy of intravenous immunoglobulin and corticosteroid in the treatment of toxic epidermal necrolysis and Stevens-Johnson syndrome: A retrospective comparative study in China. Int J Dermatol. 2009;48:1122-8.

Egan CA, Grant WJ, Morris SE, Saffle JR, Zone JJ. Plasmapheresis as an adjunct treatment in toxic epidermal necrolysis. J Am Acad Dermatol. 1999;40:458-61.

Heng MC, Allen SG. Efficacy of cyclophosphamide in toxic epidermal necrolysis. Clinical and pathophysiologic aspects. J Am Acad Dermatol. 1991;25:778-86.

Wolkenstein P, Latarjet J, Roujeau JC, Duguet C, Boudeau S, Vaillant L, et al. Randomised comparison of thalidomide versus placebo in toxic epidermal necrolysis. Lancet. 1998;352:1586-9.

Bhana N. Granulocyte colony-stimulating factors in the management of chemotherapy-induced neutropenia: evidence based review. Curr Opin Oncol. 2007;19(4):328-35.

Jarrett P, Rademaker M, Havill J, Pullon H. Toxic epidermal necrolysis treated with cyclosporin and granulocyte colony stimulating factor. Clin Exp Dermatol. 1997;22(3):146-7.

de Sica-Chapman A, Williams G, Soni N, Bunker CB. Granulocyte colony‐stimulating factor in toxic epidermal necrolysis (TEN) and Chelsea & Westminster TEN protocol. Br J Dermatol. 2010;162:860– 5.

Rutella S, Zavala F, Danese S, Kared H, Leone G. Granulocyte colony-stimulating factor: a novel mediator of T cell tolerance. J Immunol. 2005;175(11):7085-91.

Fang Y, Gong S, Xu Y, Hambly B, Bao S. Impaired cutaneous wound healing in granulocyte/ macrophage colony‐stimulating factor knockout mice. Br J Dermatol. 2007;157:458-65.