Abstract
A 75-year-old man was administered imipenem and cilastatin (IPM/CS) intravenously for gall bladder infection and liver abscess. He also developed cardiopulmonary arrest due to coronary artery dysfunction and was treated in a coronary care unit. He developed erythema covering his entire body 20 days after starting IPM/CS, which was discontinued immediately, and treatment with meropenem (MEPM) was started ; however, the skin lesions exacerbated and MEPM was discontinued. Four days after discontinuation of MEPM, wide spread bullae and Nicolsky sign were observed, and a skin biopsy specimen from a macular lesion showed epidermal necrosis with extensive apoptosis and subepidermal bullae. Therefore, he was diagnosed with toxic epidermal necrolysis (TEN) and steroid pulse therapy (methyl prednisolone 1000mg/day for 3 days) was performed. Despite the therapy, his skin lesions did not heal and so plasma exchange therapy (PE) was performed for 2 days. After the second PE, exudation from the erosion stopped and he recovered. A lymphocyte stimulation test with MEPM gave a positive result, suggesting that not only IPM/CS but also MEPM were the causative drugs of TEN. In conclusion, PE should be considered as a useful treatment for patients with TEN induced by drugs, even if the patient is in a serious condition and shows little response to corticosteroid therapy.
