A Case of Toxic Epidermal Necrolysis Successfully Treated with Intravenous Immunoglobulin Therapy

Abstract

　A 50-year-old woman was admitted to the neurosurgery department for cerebral aneurysm and subarachnoid hemorrhage. Neurosurgeons performed burr-hole drainage and internal carotid artery trapping. Administration of Lansoprazole was started 8 days before our first medical examination. Five days after lansoprazole administration, skin eruptions distributed on the trunk were observed. We had stopped the administration, but the erythematous skin lesions spread all over her body, accompanied by skin erosion and detachment. She developed skin detachment involving 36% of the skin surface. Histopathology of the skin revealed necrotic keratinocytes in the epidermis and liquefaction degeneration in the basal layer of the epidermis by HE staining. Therefore, we diagnosed the rash as toxic epidermal necrolysis. As we could not exclude the possibility that she had pneumonia, we administered intravenous immunoglobulin at a dose of 20 g/day for 5 days. Three days after intravenous immunoglobulin administration, the rash stopped spreading. Therefore, we did not add oral prednisolone therapy after intravenous immunoglobulin. This case implies that intravenous immunoglobulin monotherapy may be a useful treatment for certain kinds of toxic epidermal necrolysis.