薬剤性中毒性表皮壊死症に対して血しょう交換が奏効した１症例

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  • A case of drug-induced toxic epidermal necrolysis improved by plasma exchange

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A 39-year-old female diagnosed as cerebral sinus thrombosis was hospitalized and treated with urokinase, heparin, and several anticonvulsants. Edematous erythema appeared on the trunk and both the upper and lower limbs along with granulocytopenia after 17 days medication. Corticosteroid therapy failed to prevent the lesions from extending gradually to the entire surface of the body and 80% of the lesion showed necrolysis of epidermis. We suspected it as toxic epidermal necrolysis (TEN) caused by some of anticonvulsants. We started sodium valproate instead of the previous ones and performed three plasma exchanges (PEs) on alternate days. Epithelization was recognized on facial skin on the following day of of the last PE and almost comleted covering whole body surface within the next ten days. Lymphocyte transformation test was done on four anticonvulsants that she had administered and the only phenytoin resulted in positive. Our results suggest that PE should be applied to the patients with drug-induced TEN which is resistant to corticosteroid.

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