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The use of etanercept for treatment of toxic epidermal necrolysis when toxic shock syndrome is in the differential
Author(s) -
So Naomi,
Leavitt Erica,
Aleshin Maria,
Worswick Scott
Publication year - 2018
Publication title -
dermatologic therapy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.595
H-Index - 68
eISSN - 1529-8019
pISSN - 1396-0296
DOI - 10.1111/dth.12684
Subject(s) - etanercept , medicine , toxic epidermal necrolysis , dermatology , toxic shock syndrome , tumor necrosis factor alpha , necrosis , surgery , pathology , staphylococcus aureus , biology , bacteria , genetics
Toxic shock syndrome (TSS) can sometimes mimic Steven Johnsons syndrome/toxic epidermal necrolysis (SJS/TEN). Tumor necrosis factor (TNF) alpha is thought to play a role in the pathogenesis of both TSS and SJS/TEN. Etanercept, a TNF‐alpha inhibitor has been recently shown to treat and decrease mortality of SJS/TEN. We report a 51‐year‐old female with history of SJS presenting with painful skin and bullae 2 days following cystoscopy with botulinum toxin injection into the bladder. Due to initial concern for SJS/TEN, the patient was treated with 50 mg of subcutaneous etanercept. Punch biopsies were not consistent with SJS, and the patient fulfilled five out of five criteria for a confirmed case of TSS. The patient ultimately had a favorable outcome despite etanercept treatment. Ultimately, TNF‐alpha antagonists are an emerging therapy to treat SJS/TEN, and are unlikely to worsen TSS prognosis. Given that etanercept can be used to successfully treat SJS/TEN and TNF‐alpha levels are elevated in TSS, if a dermatologist chooses to treat TEN with etanercept, consideration of TSS on the differential should not necessarily exclude etanercept as a reasonable treatment option.