A Different Approach to Toxic Epidermal Necrolysis: Cytokine Filter

Abstract

Toxic epidermal necrolysis (TEN) is a potentially life-threatening dermatologic disorder that erythema and exfoliation of the skin involve more than 30% of the body surface and usually drug related. A 68-year-old male patient who was admitted to the emergency department with the complaint of extensive bullous lesions on his skin was followed up in the intensive care unit (ICU) with the diagnosis of TEN. He had been on multiple anti-inflammatory, antibiotic and analgesic treatment for approximately 20 days due to respiratory tract infection and gout. Methyl-prednisolone 1 g day(-1) was started after the patient's previous treatments were discontinued. The patient was connected to the mechanical ventilator on 11th day due to sepsis and respiratory mucosal involvement. Regression and epithelialisation of skin lesions started after starting cytokine filter treatment on 14th day. The cytokine filter was applied with a renal replacement therapy machine in our patient. Withdrawal of suspected drugs, maintaining an optimal electrolyte balance, sterile care of skin lesions and management in the ICU of specialised centres are essential. Although agents, such as corticosteroids, intravenous immunoglobulins and cyclosporine, are used in the treatment, we think that the use of cytokine filters will contribute to recovery by stopping the cytokine storm in these cases.