A case in which a hemodialysis patient died of toxic epidermal necrolysis caused by meropenem

Abstract

A 78‒year‒old female patient had been undergoing hemodialysis for 18 years. She had a history of right pyonephrosis 4 years ago, which had been relieved by conservative treatment with 0.5 g/day meropenem (MEPM) for 10 days at our hospital. However, she was hospitalized due to the recurrence of right pyonephrosis in year X. Conservative treatment with 0.5 g/day MEPM was started. After admission, the indications of inflammation in her laboratory data improved, but on the 11th day of the illness, erythema with pruritus appeared around her eyes. On the 13th day of the illness, the erythema rapidly spread to her trunk, so she was referred to a dermatologist. She was diagnosed with drug eruptions due to MEPM. The MEPM was discontinued, and anti‒allergic drugs were started. However, on the 15th day of the illness, the eruptions worsened rapidly, and erosive lesions and blisters appeared all over her body. As a result, she was diagnosed with toxic epidermal necrolysis (TEN). Steroid pulse therapy was administered, but epidermal necrosis was observed all over her body. On the 19th day of the illness, hemodialysis became difficult, and she died on the 21st day. TEN is a very rare, but severe, drug eruption with a mortality rate of about 30％ and has a poor prognosis when it occurs in hemodialysis patients.