Rapidly Progressing Severe Cutaneous Adverse Reaction With Acute Kidney Injury After Drug Exposure: An Uncommon Presentation.
Toxic epidermal necrolysis syndrome (TEN) is a rare severe cutaneous adverse drug reaction that involves skin and mucous membranes. We describe a case of TEN presenting with stage III acute kidney injury, rhabdomyolysis, and acute respiratory failure likely triggered by allopurinol for recently diagnosed gout. Prompt diagnosis, multidisciplinary management, including aggressive resuscitation, cardiorespiratory support, intravenous immunoglobulin therapy, and daily wound care resulted in a positive outcome despite a predicted mortality greater than 60%. Although allopurinol is a known triggering agent, TEN presenting with rhabdomyolysis and acute kidney injury is rare.
Department of Anesthesiology, Vanderbilt University, Nashville, TN.
Bradley K
BK
Rodgers
Avinash B
AB
Kumar
D058186:Acute Kidney Injury / Q000139:chemically induced*; D000493:Allopurinol / Q000009:adverse effects*; D005260:Female; D006073:Gout / Q000188:drug therapy; D006074:Gout Suppressants / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D012131:Respiratory Insufficiency / Q000139:chemically induced; D012206:Rhabdomyolysis / Q000139:chemically induced; D013262:Stevens-Johnson Syndrome / Q000209:etiology*
D006074:Gout Suppressants; D000493:Allopurinol