AB262. SOH26AB_0059. The management of toxic epidermal necrolysis syndrome in an intensive care unit: a case report
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AB262. SOH26AB_0059. The management of toxic epidermal necrolysis syndrome in an intensive care unit: a case report

Gavin O’Connor1, Ali Al-Baghdadi2, Hilary O’Leary2, Catherine Nix1, Jonathan Roddy1, Seosamh O’Riain1

1Department of Anaesthesiology, Intensive Care, and Pain Medicine, University Hospital Limerick, Limerick, Ireland; 2Department of Haematology, University Hospital Limerick, Limerick, Ireland

Background: Toxic epidermal necrolysis syndrome (TENS) is a severe skin condition characterised by widespread detachment of the skin and mucous membranes. It is a life-threatening emergency caused by an immunological reaction to a foreign substance, such as medication. TENS is an extreme form of Stevens-Johnson syndrome and involves more than 30% of the body surface area. Due to the large areas of exposed skin, patients suffer conditions such as pain, infection, hypothermia, and dehydration. The main treatment of TENS is supportive, with a multidisciplinary team required.

Case Description: A middle-aged male was admitted to the intensive care unit (ICU) with TENS. He suffered from follicular lymphoma and was receiving vincristine, cyclophosphamide, rituximab, and prednisolone. He presented repeatedly to the dermatology outpatient department (OPD) with a widespread body rash. Erythema multiforme was initially diagnosed due to septrin, allopurinol, or chemotherapy. He then presented to the hospital with a worsening rash, fever, and temperature. Sepsis was diagnosed. Due to his high nursing requirements and arrhythmias, he was moved to the ICU. The patient was intubated due to increasing oxygen requirements and to insert amniotic membranes to the eyes. The patient experienced multiple complications such as sepsis, arrhythmias, anaemia, thrombocytopaenia, hypernatraemia, increasing vasopressor and oxygen requirements. A multidisciplinary team was involved in his care, with international expert medical opinion sought.

Conclusions: TENS is a rare, life-threatening dermatological disorder. Evidence-based medicine promotes the use of supportive care. Interventions such as intravenous immunoglobulin (IVIG), biologics, and high-dose steroids have a poor evidence base. The “SCORTEN” score can be used to predict the mortality of patients with TENS.

Keywords: Chemotherapy; dermatology; toxic epidermal necrolysis syndrome (TENS); Stevens-Johnson syndrome; case report

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Footnote

Funding: None.

Conflicts of Interest: The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

doi: 10.21037/map-26-ab262
Cite this abstract as: O’Connor G, Al-Baghdadi A, O’Leary H, Nix C, Roddy J, O’Riain S. AB262. SOH26AB_0059. The management of toxic epidermal necrolysis syndrome in an intensive care unit: a case report. Mesentery Peritoneum 2026;10:AB262.

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