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Toxic Epidermal Necrolysis: Granulocytic Leukopenia as a Prognostic Indicator

Toxic Epidermal Necrolysis: Granulocytic Leukopenia as a Prognostic Indicator Abstract • Drug-induced toxic epidermal necrolysis is a disease of severe morbidity and high mortality. In the ten cases reported herein, therapeutic measures, including antibiotics, closed mechanical ventilation, maintenance of fluid and electrolyte balance, and management in special burn-care units, failed to alter a poor prognosis. The administration of corticosteroids was of no apparent benefit and may have been detrimental. Young age seemed to have a favorable influence on survival. There developed a pattern of leukopenia due to severe granulocytopenia that proved to be of prognostic importance. Persistence of the granulocytopenia portended a fatal outcome, whereas recovery of the granulocyte count to normal indicated, overall, a more favorable trend. The cause of the granulocytopenia could not be determined. (Arch Dermatol 1984;120:721-726) References 1. Lyell A: Toxic epidermal necrolysis: An eruption resembling scalding of the skin . Br J Dermatol 1956;68:355-361.Crossref 2. Lyell A: A review of toxic epidermal necrolysis in Britain . Br J Dermatol 1967;79:662-671.Crossref 3. Lyell A: Toxic epidermal necrolysis (the scalded skin syndrome): A reappraisal . Br J Dermatol 1979;100:69-86.Crossref 4. Elias PM, Fritsch P, Epstein EH Jr: Staphylococcal scalded skin syndrome: Clinical features, pathogenesis, and recent microbiological and biochemical developments . Arch Dermatol 1977;113:207-219.Crossref 5. Walker J: Toxic epidermal necrolysis: Theoretical considerations regarding its etiology and pathogenesis . Med Proc 1962;8:208-215. 6. Houwerzijl J, DeCast GC, Nater JP, et al: Lymphocyte stimulation tests and patch tests in carbamazepine hypersensitivity . Clin Exp Immunol 1977;29:272-277. 7. Zucker Von G, Stiller D: Zur immunologischen in-vitro-diagnostik des Lyell-Syndromes . Dermatol Monatsschr 1978;164:521-525. 8. Pruitt BA, Goldfarb IW: Burns , in, Schmaker W, Thompson WL (eds): Critical Care: The State of the Art . Fullerton, Calif, The Society of Critical Care Medicine, 1980, vol 1, pp 1-34. 9. Goldfarb IW, Yates AP: Total Parenteral Nutrition: Concepts and Methods . Pittsburgh, Synopse Publication, 1978. 10. Radimer GF, Davis JH, Ackerman AB: Fumigant-induced toxic epidermal necrolysis . Arch Dermatol 1974;110:103-104.Crossref 11. Rasmussen JE: Erythema multiforme in children: Response to treatment with systemic corticosteroids . Br J Dermatol 1976;95:181-186.Crossref 12. Jarkowski TL, Martmer EE: Fatal reaction to sulfadimethoxine (Madribon): A case showing toxic epidermal necrolysis and leukopenia . AJDC 1962;104:669-674. 13. Sheets RF: clinical pathological conference No. 498: Drug treatment, leukopenia, exfoliation dermatitis . J Iowa Med Soc 1968;58:1153-1165. 14. Stein K, Schlappner OLA, Heaton CL, et al: Demonstration of basal cell immunofluorescence in drug-induced toxic epidermal necrolysis . Br J Dermatol 1972;86:246-252.Crossref 15. Björnberg A: Fifteen cases of toxic epidermal necrolysis (Lyell) . Acta Derm Venereol 1973;53:149-152. 16. Amon RB, Dimond RL: Toxic epidermal necrolysis: Rapid differentiation between staphylococcal- and drug-induced disease . Arch Dermatol 1975;111:1433-1437.Crossref 17. Mitroshina AV, Poroshina NS, Kozlova SM, et al: Lyell's syndrome with acute agranulocytosis . Klin Med 1976;54:130-132. 18. Iuldashev UI, Dymerets ESH, Nasyrova AM: Case of Lyell's syndrome with agranulocytosis . Ter Arkh 1978;50:129-131. 19. Anhalt G, Snelling CFT: Toxic epidermal necrolysis . Plast Reconstr Surg 1978;61:905-910.Crossref 20. Bondarenko YAD: Observations of patient with Lyell's syndrome . South Med J 1978;12:110-113. 21. Haynes HA: Toxic epidermal necrolysis, drug-induced. Weekly clinicopathological conferences . N Engl J Med 1978;299:33-39.Crossref 22. Levitt L, Pearson RW: Sulindac-induced Stevens-Johnson toxic epidermal necrolysis syndrome . JAMA 1980;243:1262-1263.Crossref 23. Finlay AY, Richards J, Holt PJA: Intensive therapy unit management of toxic epidermal necrolysis: Practical aspects . Clin Exp Dermatol 1982;7:55-60.Crossref 24. Dickerson W: The present status of dilantin therapy . Am J Psychiatry 1942;98:515-523. 25. Boggs DR: The leukopenic state , in Beeson PB, McDermott W (eds): Cecil Textbook of Medicine , ed 15. Philadelphia, WB Saunders Co, 1978, pp 2241-2242. 26. Misgeld V: Zur Frage der Immunopathogenese des Lyell-Syndroms . Z Hautkr 1974;49:239-246. 27. Baxter CR: Fluid volume and electrolyte changes of the early postburn period . Clin Plast Surg 1974;1:693-709. 28. Hammerschmidt DE, Stroncek DF, Bowers TK, et al: Complement activation and neutropenia occurring during cardiopulmonary bypass . J Thorac Cardiovasc Surg 1981;81:370-377. 29. Jacob HS, Hammerschmidt DE: Complement induced granulocyte aggregation: Importance in myocardial infarction and shock lung . JAMA 1981;245:2013-2017.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Toxic Epidermal Necrolysis: Granulocytic Leukopenia as a Prognostic Indicator

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References (32)

Publisher
American Medical Association
Copyright
Copyright © 1984 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1984.01650420031010
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Abstract

Abstract • Drug-induced toxic epidermal necrolysis is a disease of severe morbidity and high mortality. In the ten cases reported herein, therapeutic measures, including antibiotics, closed mechanical ventilation, maintenance of fluid and electrolyte balance, and management in special burn-care units, failed to alter a poor prognosis. The administration of corticosteroids was of no apparent benefit and may have been detrimental. Young age seemed to have a favorable influence on survival. There developed a pattern of leukopenia due to severe granulocytopenia that proved to be of prognostic importance. Persistence of the granulocytopenia portended a fatal outcome, whereas recovery of the granulocyte count to normal indicated, overall, a more favorable trend. The cause of the granulocytopenia could not be determined. (Arch Dermatol 1984;120:721-726) References 1. Lyell A: Toxic epidermal necrolysis: An eruption resembling scalding of the skin . Br J Dermatol 1956;68:355-361.Crossref 2. Lyell A: A review of toxic epidermal necrolysis in Britain . Br J Dermatol 1967;79:662-671.Crossref 3. Lyell A: Toxic epidermal necrolysis (the scalded skin syndrome): A reappraisal . Br J Dermatol 1979;100:69-86.Crossref 4. Elias PM, Fritsch P, Epstein EH Jr: Staphylococcal scalded skin syndrome: Clinical features, pathogenesis, and recent microbiological and biochemical developments . Arch Dermatol 1977;113:207-219.Crossref 5. Walker J: Toxic epidermal necrolysis: Theoretical considerations regarding its etiology and pathogenesis . Med Proc 1962;8:208-215. 6. Houwerzijl J, DeCast GC, Nater JP, et al: Lymphocyte stimulation tests and patch tests in carbamazepine hypersensitivity . Clin Exp Immunol 1977;29:272-277. 7. Zucker Von G, Stiller D: Zur immunologischen in-vitro-diagnostik des Lyell-Syndromes . Dermatol Monatsschr 1978;164:521-525. 8. Pruitt BA, Goldfarb IW: Burns , in, Schmaker W, Thompson WL (eds): Critical Care: The State of the Art . Fullerton, Calif, The Society of Critical Care Medicine, 1980, vol 1, pp 1-34. 9. Goldfarb IW, Yates AP: Total Parenteral Nutrition: Concepts and Methods . Pittsburgh, Synopse Publication, 1978. 10. Radimer GF, Davis JH, Ackerman AB: Fumigant-induced toxic epidermal necrolysis . Arch Dermatol 1974;110:103-104.Crossref 11. Rasmussen JE: Erythema multiforme in children: Response to treatment with systemic corticosteroids . Br J Dermatol 1976;95:181-186.Crossref 12. Jarkowski TL, Martmer EE: Fatal reaction to sulfadimethoxine (Madribon): A case showing toxic epidermal necrolysis and leukopenia . AJDC 1962;104:669-674. 13. Sheets RF: clinical pathological conference No. 498: Drug treatment, leukopenia, exfoliation dermatitis . J Iowa Med Soc 1968;58:1153-1165. 14. Stein K, Schlappner OLA, Heaton CL, et al: Demonstration of basal cell immunofluorescence in drug-induced toxic epidermal necrolysis . Br J Dermatol 1972;86:246-252.Crossref 15. Björnberg A: Fifteen cases of toxic epidermal necrolysis (Lyell) . Acta Derm Venereol 1973;53:149-152. 16. Amon RB, Dimond RL: Toxic epidermal necrolysis: Rapid differentiation between staphylococcal- and drug-induced disease . Arch Dermatol 1975;111:1433-1437.Crossref 17. Mitroshina AV, Poroshina NS, Kozlova SM, et al: Lyell's syndrome with acute agranulocytosis . Klin Med 1976;54:130-132. 18. Iuldashev UI, Dymerets ESH, Nasyrova AM: Case of Lyell's syndrome with agranulocytosis . Ter Arkh 1978;50:129-131. 19. Anhalt G, Snelling CFT: Toxic epidermal necrolysis . Plast Reconstr Surg 1978;61:905-910.Crossref 20. Bondarenko YAD: Observations of patient with Lyell's syndrome . South Med J 1978;12:110-113. 21. Haynes HA: Toxic epidermal necrolysis, drug-induced. Weekly clinicopathological conferences . N Engl J Med 1978;299:33-39.Crossref 22. Levitt L, Pearson RW: Sulindac-induced Stevens-Johnson toxic epidermal necrolysis syndrome . JAMA 1980;243:1262-1263.Crossref 23. Finlay AY, Richards J, Holt PJA: Intensive therapy unit management of toxic epidermal necrolysis: Practical aspects . Clin Exp Dermatol 1982;7:55-60.Crossref 24. Dickerson W: The present status of dilantin therapy . Am J Psychiatry 1942;98:515-523. 25. Boggs DR: The leukopenic state , in Beeson PB, McDermott W (eds): Cecil Textbook of Medicine , ed 15. Philadelphia, WB Saunders Co, 1978, pp 2241-2242. 26. Misgeld V: Zur Frage der Immunopathogenese des Lyell-Syndroms . Z Hautkr 1974;49:239-246. 27. Baxter CR: Fluid volume and electrolyte changes of the early postburn period . Clin Plast Surg 1974;1:693-709. 28. Hammerschmidt DE, Stroncek DF, Bowers TK, et al: Complement activation and neutropenia occurring during cardiopulmonary bypass . J Thorac Cardiovasc Surg 1981;81:370-377. 29. Jacob HS, Hammerschmidt DE: Complement induced granulocyte aggregation: Importance in myocardial infarction and shock lung . JAMA 1981;245:2013-2017.Crossref

Journal

Archives of Dermatology – American Medical Association

Published: Jun 1, 1984

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