Did you read Case 34-2005 NEJM??

[seewell]

Did anyone read this?

Case records of the Massachusetts General Hospital. Case 34-2005. A 10-year-old girl with a bullous skin eruption and acute respiratory failure.
Sheridan RL, Liu V, Anupindi S
N Engl J Med 2005 Nov;353(19):2057-66

I'd love to hear your thoughts!

 

[Mumpu]

My diagnosis is:
1) Bullous skin eruption
2) Acute respiratory failure

Differential includes non-bullous non-skin non-eruption and acute respiratory success.

 

[DrNick2006]

my DDx of bullous skin lesions in a child:

1. Stevens-johnson/toxic epidermal necrolysis
2. Staphlococcal scalded skin syndrome
3. pemphigus vulgaris
4. bullous pemphigoid

 

[Mumpu]

Tegretal-induced TEN was the right answer. Nicely done DrNick!

 

[seewell]

Thought this was interesting commentary on this case too:

http://journalreview.org/view_pubmed_article.php?pmid=16282181&specialty_id=22

Key aspects missing from this report
Thu 11/17/2005 PM

After reading this elegantly written case, one has to wonder if it was reviewed by an expert in the case at hand. I mention this for two key reasons:

1. In the case, the use of IvIG is reported. However, the dosage used is not. It is clear based on previous published work that the dose of IvIG is important, and that lower doses tend not to work. Doses of 3-4grams/kg are typically required, and are given over a period of 3-4days. Lower doses have been shown to be ineffective.

2. In the discussion, alternatives to treatment are incomplete. For example, no mention of the use of Cyclospirne is given. This is a medication that is inexpensive, and readily available. There are physicians now who use it first line when confronted with a case of toxic epidermal necrolysis for just this reason.