Abstract
Background: Toxic Epidermal Necrolysis (TEN) is a dermatological emergency characterized by generalized epidermal necrolysis, causing peeling of the skin, which becomes susceptible to serious infections. It presents multisystemic involvement, with high morbidity and mortality. The management of TEN is multifaceted, and begins with identifying and removing the causative agent. Identification of the agent depends on a complete clinical history, as symptoms generally present within eight weeks of initiating drug therapy. Suspending the causative drug is fundamental in the evolution of the pathology and clinical success depends, mainly, on supportive treatment, to avoid complications, such as sepsis.
Aim: To report a single case of NET seen in our service. Method: This is a case report of a patient treated at the Hospital Universitário São Francisco na Providência de Deus – HUSF, located in the city of Bragança Paulista – SP, Brazil.
Case Report: The case reported in this paper was a 33-year-old male patient, with no known comorbidities, who presented with pruritic and painful erythematous vesicular lesions, initially in the groin region and upper limbs, with progression to the trunk and lower limbs, associated with fever, ocular hyperemia and conjunctivitis. The patient also had anemia, elevated CRP and hypoalbuminemia, but with normal renal and hepatic function. Serologies for HIV and syphilis were performed, with positive results. During hospitalization, the lesions rapidly worsened, with mucosal involvement, skin peeling and epidermal detachment, raising the suspicion of TEN. The patient was admitted to the ICU due to generalized involvement, newly diagnosed HIV and risk of sepsis. Treatment included isolation, intensive skin care, cyclosporine, benzathine penicillin due to the diagnosis of syphilis and antiretroviral therapy for HIV, leading to significant improvement. After 11 days of hospitalization, the patient was discharged from the hospital and maintained outpatient follow-up with an infectious disease specialist and dermatologist.
Conclusion: This paper highlighted a clinical case that illustrates the diversity of scenarios in which TEN can occur, emphasizing the importance of early recognition, multidisciplinary treatment and appropriate management to improve the outlook for patients, especially those who are immunosuppressed. Furthermore, awareness about TEN, especially in relation to specific medications, is crucial to ensure effective management and follow-up of patients, especially those with underlying health conditions.
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