Successful multidisciplinary treatment for toxic epidermal necrolysis in a hemodialysis patient presenting with acute myeloid leukemia： A case report

Abstract

We report a case of toxic epidermal necrolysis (TEN) in a hemodialysis patient with acute myeloid leukemia (AML) that was treated successfully with multidisciplinary therapy. A 44‒year‒old man, who had been undergoing maintenance hemodialysis since the age of 38, was diagnosed with AML 4 months earlier. After diagnosis, he was treated with remission induction therapy and achieved remission. Thereafter, he underwent two monthly cycles of consolidation chemotherapy. He was subsequently re‒admitted to our hospital for a third round of consolidation chemotherapy. On the 12th day of hospitalization, he developed a high fever and general fatigue. He was diagnosed with febrile neutropenia due to chemotherapy. He was administered wide‒spectrum antibiotics; however, his fever did not improve. On the 14th day, antibiotics were changed, and intravenous immunoglobulin was administered. On the same day, the patient developed generalized erythema, blisters, and oral cavity erosions. Two days later, a diagnosis of TEN was made based on clinical findings and a skin biopsy that revealed necrosis across all layers of the epidermis. Steroid pulse therapy and plasma exchange (PE), performed three times in total, were initiated promptly after the diagnosis. Following the third PE, no further exacerbation of TEN was observed. The patient was discharged on the 85th day. TEN is a rare and severe medication reaction with a poor prognosis, and its mortality rate in hemodialysis patients is over ten times higher than in the general population.