Ileal involvement in toxic epidermal necrolysis (Lyell syndrome).
Intestinal involvement in toxic epidermal necrolysis (TEN) has been identified only rarely. This report describes a case of TEN with ileal manifestations characterized by a profuse diarrhea with malabsorption, protein-losing enteropathy, and radiologically by multiple stenosis. After healing of the cutaneous lesions, total parenteral nutrition was initiated, resulting in a decreased diarrhea. However, after one month of total parenteral nutrition, malabsorption and protein-losing enteropathy continued and the radiological lesions were still present with an aspect consistent with a sclerotic process. A surgical resection of the pathological ileal segment was performed with end-to-end anastomosis. Pathological examination of the resected segment showed a necrosis of the ileal mucosa with a pattern similar to that of the epidermal necrosis. No sclerosis was observed. It seems that a prolonged total parenteral nutrition could have induced a complete healing of intestinal lesions. This case report is the first clinical, radiological, and histological study of an ileal involvement in TEN.
Michel
P
P
Service des maladies de l'Appareil digestif et de la Nutrition, Hôpital Charles Nicolle, Rouen, France.
Joly
P
P
Ducrotte
P
P
Hemet
J
J
Leblanc
I
I
Lauret
P
P
Lerebours
E
E
Colin
R
R
D003967:Diarrhea / Q000209:etiology; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000209:etiology* / Q000473:pathology / Q000628:therapy; D007082:Ileum / Q000473:pathology; D008286:Malabsorption Syndromes / Q000209:etiology; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011504:Protein-Losing Enteropathies / Q000209:etiology; D013262:Stevens-Johnson Syndrome / Q000150:complications*