Acute compartment syndrome of the forearm as a rare complication of toxic epidermal necrolysis: A case report

被引:1
作者
Kamal T. [1 ,2 ]
Elnikety S. [1 ]
Mashaly H. [2 ]
Casha J. [1 ]
机构
[1] Queen Elizabeth, Queen Mother Hospital, Margate CT9 4AN, St Peters Road
[2] Kasr El Eini Hospital, Cairo University Hospital, Cairo
关键词
Body Surface Area; Allopurinol; Compartment Syndrome; Toxic Epidermal Necrolysis; Blister Fluid;
D O I
10.1186/1752-1947-6-84
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学科分类号
摘要
Introduction. Toxic epidermal necrolysis lies within the spectrum of severe cutaneous adverse reactions induced by drugs, affecting skin and mucous membranes. Toxic epidermal necrolysis is considered a medical emergency as it is considered to be potentially fatal and carries a high mortality rate. To the best of our knowledge the association of toxic epidermal necrolysis and compartment syndrome has been rarely mentioned in the literature. In this case we treated the compartment syndrome promptly despite the poor general condition and skin status of our patient. Despite the poor skin condition, wound healing was uneventful with no complications. Case presentation. A 62-year-old Caucasian man with a generalized macular-vesicular rash involving 90% of his body surface area and mucous membranes, as well as impaired renal and hepatic functions following ingestion of allopurinol for treatment of gout, was admitted to our hospital. Skin biopsies were taken and he was started on a steroid infusion. Within hours of admission, he developed acute compartment syndrome of the dominant forearm and hand. Conclusions: Despite its rare incidence, toxic epidermal necrolysis is a condition with a high incidence of complications and mortality. Patients with severe conditions affecting a large degree of the skin surface area should be treated as promptly and effectively as patients with burns, with close monitoring and the anticipation that rare musculoskeletal complications might arise. The association of compartment syndrome and toxic epidermal necrolysis might lead to a rapid deterioration and fatal systemic involvement and multiple organ failures. © 2012 Kamal et al; licensee BioMed Central Ltd.
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  • [1] Mockenhaupt M., Severe drug-induced skin reactions: Clinical pattern, diagnostics and therapy, J Dtsch Dermatol Ges, 7, pp. 142-160, (2009)
  • [2] Mockenhaupt M., The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis, Exp Rev Clin Immunol, 7, pp. 803-813, (2011)
  • [3] Torres M.J., Mayorga C., Blanca M., Nonimmediate allergic reactions induced by drugs: Pathogenesis and diagnostic tests, J Investig Allergol Clin Immunol, 19, pp. 80-90, (2009)
  • [4] Roujeau J.C., Kelly J.P., Naldi L., Rzany B., Stern R.S., Anderson T., Auquier A., Bastuji-Garin S., Correia O., Locati F., Mockenhaupt M., Paoletti C., Shapiro S., Shear N., Schopf E., Kaufman D.W., Medication use and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis, N Engl J Med, 333, pp. 1600-1607, (1995)
  • [5] Mockenhaupt M., Viboud C., Dunant A., Naldi L., Halevy S., Bavinck J.N.B., Sidoroff A., Schneck J., Roujeau J.-C., Flahault A., Stevens-Johnson syndrome and toxic epidermal necrolysis: Assessment of medication risks with emphasis on recently marketed drugs. The EuroSCAR-study, Journal of Investigative Dermatology, 128, 1, pp. 35-44, (2008)
  • [6] Halevy S., Ghislain P.-D., Mockenhaupt M., Fagot J.-P., Bouwes Bavinck J.N., Sidoroff A., Naldi L., Dunant A., Viboud C., Roujeau J.-C., Allopurinol is the most common cause of Stevens-Johnson syndrome and toxic epidermal necrolysis in Europe and Israel, Journal of the American Academy of Dermatology, 58, 1, pp. 25-32, (2008)
  • [7] Halevy S., Stevens-Johnson syndrome and toxic epidermal necrolysis - Updates and innovations, Harefuah, 149, pp. 186-190, (2010)
  • [8] Laurisch S., Jaedtke M., Demir R., Sorrentino S.A., Kielstein J.T., Rennekampff H.O., Vogt P.M., Meyer G.P., Fuchs M., Klein G., Drexler H., Schieffer B., Napp L.C., Allopurinol-induced hypersensitivity syndrome resulting in death, Med Klin (Munich), 105, pp. 262-266, (2010)
  • [9] Ventura F., Fracasso T., Leoncini A., Gentile R., De Stefano F., Death caused by toxic epidermal necrolysis (Lyell syndrome), J Forensic Sci, 55, pp. 839-841, (2010)
  • [10] Bastuji-Garin S., Rzany B., Stern R.S., Shear N.H., Naldi L., Roujeau J.-C., Clinical classification of cases of toxic epidermal necrolysis, Stevens- Johnson syndrome, and erythema multiforme, Archives of Dermatology, 129, 1, pp. 92-96, (1993)