title: A case of toxic epidermal necrolysis with diverse etiologies: successful treatment with intravenous immunoglobulin and pulse prednisolone and effects on sTRAIL and sCD200 levels.
abstract: BACKGROUND
  Here, we report the first case of patient with intracranial tumors (ICT) who developed a cutaneous adverse drug reaction during lansoprazole and prophylactic anticonvulsant treatment. SCORTEN is a scoring system used to predict mortality in TEN patients. If SCORTEN index is 5 or more, mortality rate is more than 90%. SCORTEN of our patient was calculated as 5.
  
  
  METHODS
  Our patient is a 64 year-old white female, who had glioma and had been on post-op prophylactic anticonvulsant therapy. On the 3rd day post operation, lansoprazole was added to the therapy. After the first lansoprazole dose, erythematous dusky red macules occurred on extremities and trunk and on the following day confluent purpuric lesions tended to run together in 95% of the whole body including scalp, oral and genital mucosa. Nikolsky's Sign was positive on the skin. Physical examination; body temperature was 38.4 degrees C with a heart rate of 146 beats/minute and 80/50 mm Hg arterial blood pressure, Glascow Coma Scale was E1 M1e, pupillary light reflex was 2/2 +/+ and she was confused. Her biopsy resulted as toxic epidermal necrolysis. Moreover, sTRAIL and sCD200 levels of serum and blister fluid were investigated as an apoptotic marker and a negative marker for inflammation.
  
  
  CONCLUSIONS
  sTRAIL and sCD200 were evaluated both in the sera and blister fluid. sTRAIL level was lower than for healthy individuals with high levels in blister fluid; and sCD200 level was depressed by up to 10% of the normal values of healthy individuals but with high levels in the blister fluid during the active phase of the disease. After our successful treatment with human albumin, prednisolone pulse therapy, and IVIG at a dose of 400 mg/kg, she was discharged from the hospital on the 23rd day and followed up after 2 months. The increase in sTRAIL (up to two-fold) and sCD200 (up to six-fold) levels may provide useful information in understanding disease pathogenesis and monitoring treatment efficacy.
authors.affiliation: Department of Internal Medicine, Allergy and Clinical Immunology Unit, Antalya Training and Research Hospital, Antalya, Turkey. adidyal@yahoo.com
authors.forename: Arzu Didem
authors.initials: AD
authors.lastname: Yalcin
authors.forename: Ayse Akman
authors.initials: AA
authors.lastname: Karakas
authors.forename: Gokalp
authors.initials: G
authors.lastname: Soykam
authors.forename: Reginald M
authors.initials: RM
authors.lastname: Gorczynski
authors.forename: Cem
authors.initials: C
authors.lastname: Sezer
authors.forename: Atil
authors.initials: A
authors.lastname: Bisgin
authors.forename: Ludwig G
authors.initials: LG
authors.lastname: Strauss
mesh_terms: D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D015703:Antigens, CD / Q000097:blood*; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008875:Middle Aged; D011239:Prednisolone / Q000627:therapeutic use*; D012867:Skin / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000473:pathology; D053221:TNF-Related Apoptosis-Inducing Ligand / Q000097:blood*
chemical_list: D000893:Anti-Inflammatory Agents; D015703:Antigens, CD; D016756:Immunoglobulins, Intravenous; D053221:TNF-Related Apoptosis-Inducing Ligand; C505653:TNFSF10 protein, human; D011239:Prednisolone; C042739:antigens, CD200