A SEVERE FORM OF TOXIC EPIDERMAL NECROLYSIS [LYELLS SYNDROME] – A CASE REPORT

Dr.S.N.SARAVANA SUNDARAM; Dr.PATHIVADA SANDEEP NAIDU; Prof.R.V.M.SURYA RAO; Dr.D.ALAGAR RAJA; Dr.S.NARAYANAMURTHY; Dr.R.MANIMARAN.

Volume : VIII, Issue : V, May - 2019

A SEVERE FORM OF TOXIC EPIDERMAL NECROLYSIS [LYELLS SYNDROME] – A CASE REPORT

Dr. S. N. Saravana Sundaram, Dr. Pathivada Sandeep Naidu, Prof. R. V. M. Surya Rao, Dr. D. Alagar Raja, Dr. S. Narayanamurthy, Dr. R. Manimaran.

Abstract :

Toxic epidermal necrolysis (TEN) and Stevens Johnson Syndrome (SJS) are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous memanes. Both are rare, with TEN and SJS affecting approximately 1or 2/1,000,000 annually, and are considered medical emergencies as they are potentially fatal. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin[1].Lyell�s syndrome is an adverse reaction to drugs which, apart from affecting blood and coagulation, mainly targets the cutaneomucous, respiratory,digestive, and urinaryepithelium.[2] Currently, TEN and SJS are considered to be two ends of a spectrum of severe epidermolytic adverse cutaneous drug reactions, differing only by their extent of skin detachment. Drugs are assumed or identified as the main cause of SJS/TEN in most cases.[1]. It may be triggered by infections, but it is believed that at least 80% of cases are caused by medications. The pharmaceuticals worth mentioning are sulfonamides, allopurinol, carbamazepine, phenytoin, and phenobarbital. It is a disease with multisystem impacts, and its clinical presentation includes skin and mucosal changes that affect more than 30% of the total body surface[3].The evolution is accompanied by local complications (superinfections, vicious scars), or general complications (sepsis, multiple organ failure)[4]. We present the case of a patient with drug–induced Lyell�s syndrome associated with exposure to a classof nativedrugs at risk of inducing Lyell�s syndrome. Supportive therapy, associated with the treatment of cutaneous mucosal lesions, and the treatment of sepsis, were the most important elements that led to a favourable evolution of our case.