Acute and chronic respiratory complications of toxic epidermal necrolysis.
Toxic epidermal necrolysis (TEN) is a rare disease resulting in bullous necrosis of the epidermis with partial-thickness loss of skin and mucous membranes. Previous reports of TEN have not focused on respiratory complications. During a 6-year period, 12 patients with biopsy-proven TEN were referred to a regional burn unit at the Wellesley Hospital, Toronto. Five patients required mechanical ventilatory support, and nine showed roentgenographic evidence of respiratory complications that had developed. Intensive therapy in a critical care burn unit resulted in a 75% survival rate. The four nonsurvivors had severe preexisting multisystem disease. Four survivors were observed prospectively, with 3 monthly pulmonary function testings performed. The four survivors tested, even if they did not require mechanical ventilatory support, showed evidence of respiratory involvement. Three patients demonstrated a persistent reduction in carbon monoxide diffusing capacity of up to 35% to 40% below normal. From our case series we suggest that TEN, although primarily a dermatologic condition, may result in life-threatening acute respiratory decompensation requiring ventilatory support and long-term pulmonary function abnormalities. Patients with TEN should be closely monitored for pulmonary complications.
McIvor
R A
RA
Division of Respirology, University of Toronto, Ontario, Canada.
Zaidi
J
J
Peters
W J
WJ
Hyland
R H
RH
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000150:complications*; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012129:Respiratory Function Tests; D012140:Respiratory Tract Diseases / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D012189:Retrospective Studies; D013262:Stevens-Johnson Syndrome / Q000150:complications* / Q000175:diagnosis; D015996:Survival Rate