title: The use of plasmapheresis in a 4-year-old boy with toxic epidermal necrosis.
abstract: BACKGROUND
  Toxic epidermal necrosis (TEN) is a severe and life-threatening syndrome manifesting as extensive necrosis of the epidermis and mucous membranes accompanied by systemic symptoms. The causative factor is exposure to drugs, such as sulphonamides, antiepileptic preparations, non-steroidal anti-inflammatory drugs and paracetamol. The mechanism leading to the development of lesions is unknown and there is no uniform strategy of management.
  
  
  METHODS
  A 4-year-old boy was admitted with late-stage TEN; he was additionally affected by partial atrophy of the corpus callosum, mental retardation and drug-resistant epilepsy. Three weeks before the first symptoms developed, antiepileptic treatment was widened with lamotrigine, which seems to be the causative factor of TEN. Since general and topical pharmacological therapy failed, plasmapheresis was applied and already after 2 cycles, the progression of lesions was inhibited and circulation was gradually stabilized.
  
  
  CONCLUSIONS
  The use of plasmapheresis in a child with TEN can result in substantial improvement of the general and local condition. The case presented clearly indicates that standards of management of children with suspected or developed TEN should be urgently instituted.
authors.affiliation: Department of Paediatric Anaesthesiology and Intensive Therapy, COPERNICUS LLC in Gdańsk, Poland. ohika@wp.pl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Hinc-Kasprzyk
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Polak-Krzemińska
authors.forename: Monika
authors.initials: M
authors.lastname: Głowacka
authors.forename: Irena
authors.initials: I
authors.lastname: Ożóg-Zabolska
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D018450:Disease Progression; D000069279:Drug Resistant Epilepsy / Q000188:drug therapy; D006801:Humans; D000077213:Lamotrigine; D008297:Male; D010956:Plasmapheresis / Q000379:methods*; D013262:Stevens-Johnson Syndrome / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D014227:Triazines / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D014227:Triazines; D000077213:Lamotrigine