Toxic epidermal necrolysis and graft vs. host disease: a clinical spectrum but a diagnostic dilemma.
We describe a 53-year-old man who developed partial and full thickness skin loss associated with pyrexia, diarrhoea, liver, renal and bone marrow failure, during treatment for an aggressive B cell lymphoblastic lymphoma. The clinical features and histology were compatible with both toxic epidermal necrolysis and graft vs. host disease, causing a diagnostic and therapeutic dilemma. We discuss the possibility that methotrexate was the causative drug, with review of its cutaneous side-effects. Histologically our patient demonstrated the sparse dermal infiltrate with full thickness epidermal necrosis typical of toxic epidermal necrolysis and graft vs. host disease. We discuss this finding with respect to the pathogenesis of toxic epidermal necrolysis.
Stone
N
N
Department of Dermatology, Stoke Mandeville Hosptial, Aylesbury, UK.
Sheerin
S
S
Burge
S
S
D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001855:Bone Marrow Diseases / Q000139:chemically induced; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000139:chemically induced; D017809:Fatal Outcome; D005334:Fever / Q000139:chemically induced; D006086:Graft vs Host Disease / Q000139:chemically induced / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D017093:Liver Failure / Q000139:chemically induced; D016393:Lymphoma, B-Cell / Q000188:drug therapy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000009:adverse effects; D008875:Middle Aged; D017713:Platelet Transfusion / Q000009:adverse effects; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D051437:Renal Insufficiency / Q000139:chemically induced; D013262:Stevens-Johnson Syndrome / Q000175:diagnosis* / Q000209:etiology
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate