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Case of toxic epidermal necrolysis occurring after bone marrow transplantation accompanied by engraftment failure
Author(s) -
Asai Chika,
Watanabe Yuko,
Mukaijo Junko,
Takamura Naoko,
Okawa Tomoko,
Yamaguchi Yukie,
Matsumura Ayako,
Matsumoto Kenji,
Aihara Michiko
Publication year - 2019
Publication title -
the journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.9
H-Index - 65
eISSN - 1346-8138
pISSN - 0385-2407
DOI - 10.1111/1346-8138.14913
Subject(s) - toxic epidermal necrolysis , medicine , bone marrow , erythroderma , plasmapheresis , bone marrow failure , bone marrow transplantation , transplantation , hemophagocytic lymphohistiocytosis , dermatology , pathology , surgery , immunology , antibody , stem cell , disease , haematopoiesis , biology , genetics
Toxic epidermal necrolysis ( TEN ) is a rare condition, causing life‐threatening adverse cutaneous reactions. TEN occurrence after bone marrow transplantation ( BMT ) is a well‐known phenomenon; however, to date, only a few cases have been reported in the published work. Here, we describe the case of a 53‐year‐old woman who experienced TEN after undergoing allogenic BMT for malignant lymphoma. Skin erosion spread across a maximum of 70% of the body surface area and severe mucosal lesions developed. Steroid pulse therapy, plasma apheresis and immunoglobulin therapy were administrated, which resulted in the complete resolution of TEN . However, she developed hemophagocytic lymphohistiocytosis and died 38 days after BMT , owing to rupture of the lower digestive tract complicated by multi‐organ failure. In our case, engraftment failure occurred, and the peripheral white blood cell count was less than 100/μL during the TEN course, suggesting that the presence of only a few immune cells could cause TEN . Our findings showed that high mortality rates and widespread skin erosion could be regarded as the most important characteristics of TEN occurring after BMT .