Laryngeal involvement in toxic epidermal necrolysis

Wahle, David; Beste, David J.; Conley, Stephen F.

doi:10.1177/019459988910700616.1

Cited by 13 publications

(8 citation statements)

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“…Particularly problematic is involvement of the larynx and tracheobronchial tree, which is commonly associated with airway compromise and progressive respiratory failure. [25][26][27][28][29][30] Gastrointestinal involvement is seen in the mouth, the esophagus, and even the small bowel and colon, 31,32 with both obstruction and perforation reported as complications. We have not screened for esophageal strictures with radiographs, but no child has demonstrated symptoms suggestive of this problem during the follow-up interval.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

et al. 2002

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ABSTRACT. Objective. Toxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury not just to the skin. Historically, it has been associated with a high mortality but few long-term consequences among survivors. With improved survival, long-term consequences may be becoming more apparent. The objective of this study was to define these longterm consequences and their frequency.Methods. From July 1, 1991, to June 30, 2000, 11 children with severe TEN were referred to a regional pediatric burn facility. Wounds were managed with a strategy involving prevention of wound desiccation and superinfection, including the frequent use of biological wound coverings. All children survived and have been followed in the burn clinic. The records of all children were reviewed in detail.Results. Two boys and 9 girls with an average age of 7.2 ؎ 1.8 years (range: 6 months-15 years) and sloughed surface area of 76 ؎ 6% of the body surface (range: 50%-95%) were admitted to the burn unit for care. Antibiotics (3 children), anticonvulsants (4 children), nonsteroidals (2 children), and viral syndrome or unknown agents (2 children) were believed to have triggered the syndrome. Six (55%) children required intubation for an average of 9.7 ؎ 1.8 days (range: 2-14 days). Mucosal involvement occurred in 10 (91%) and ocular involvement in 10 (91%). Lengths of stay averaged 19 ؎ 3 days (range: 6 -40 days). Overall follow-up averaged 14 ؎ 13 months. Three children had no apparent long-term consequences of the disease and were referred to primary care follow-up after the 2-month burn clinic visit. The remaining children had follow-up averaging 23 ؎ 13 months. The most common long-term morbidity involved eyes (3 children T oxic epidermal necrolysis (TEN) is an acute inflammatory systemic condition that involves injury to the skin, mucous membrane, and sometimes bowel and respiratory epithelium. The syndrome was first clearly described by Lyell in 1956 1,2 and is now believed to represent the most severe form of a disease spectrum beginning with Stevens-Johnson syndrome (SJS). [3][4][5] In SJS, mucous membranes are characteristically denuded. Some children with SJS have macular skin lesions as well, usually involving Ͻ30% of the body surface. In TEN, both skin and mucous membranes are denuded, involvement of Ͼ30% of the body surface is characteristic, 6 and mucosal surface involvement may extend into the respiratory and gastrointestinal tracts. Patients with TEN can therefore be considered as having both a cutaneous and a visceral wound. The morbidity and mortality of the condition is as related to involvement of visceral surfaces as it is to that of the cutaneous wound.[Although there are no large exclusively pediatric data sets, patients with TEN are generally reported to have a mortality as high as 70% 7 ; death usually results from sepsis or organ failure. During the past several years, these children have been increasingly referred to burn units, as their needs are similar to those of children with extensiv...

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Section: Discussionmentioning

confidence: 99%

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

et al. 2002

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“…However, it is a life-threatening disease, fatal in 30 % of cases, and death is mainly related to sepsis or visceral involvement such as gastrointestinal or pulmonary complications [9,10]. Pulmonary manifestations have been poorly studied but appear to be heterogeneous, including specific bronchial mucosal necrosis, pulmonary edema, and infectious pneumonitis, as described in a few isolated case reports or rare postmortem studies [11][12][13][14][15]. The aim of the present study was therefore to evaluate the incidence of pulmonary manifestations in TEN, to define their clinical characteristics, and to determine their prognosis in a large prospective series.…”

Section: Introductionmentioning

confidence: 99%

Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study

et al. 1997

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"Specific" involvement of bronchial epithelium was noted in 27% of cases and must be suspected when dyspnea, bronchial hypersecretion, normal chest X-ray, and marked hypoxemia are present during the early stages of toxic epidermal necrosis. Bronchial injury seems to indicate a poor prognosis, as mechanical ventilation was required for most of these patients and was associated with a high mortality.

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“…Dabei ist die Sepsis der hauptsächliche Letalitätsfaktor [13,18,20,34,35]. Angaben zum klinischen Verlauf großflächiger Epidermolysen, einhergehend mit ausgedehnten Läsionen des Endothels, finden sich in der Literatur nur selten und stützen sich auf Einzelfalldarstellungen [2,7,8,27,31,33,36,37].…”

Section: Schlüsselwörterunclassified

“…Der Häufigkeit nach werden Konjunktiven, Oropharynx, Genitale, Urethra und Anus in sehr variablem Ausmaß erfasst [5,22,34,35,36]. Ausgedehnte Störungen der Funktion des Gastrointestinal-und Respirationstraktes finden sich vergleichsweise selten [2,8,27,31,33,35,36].…”

Section: Diskussionunclassified

“…Während die Beteiligung des Oropharynx häufig auftritt und auch Fälle mit Epiglottisschwellung, pharyngealer Stenose und Bronchiolitis obliterans beschrieben worden sind [15,33], finden sich in der Literatur keine Hinweise auf die von uns beobachteten isolierten öde-matösen Schleimhautschwellungen bzw. Stenosen im Bereich des Kehlkopfes und des subglottischen Raumes.…”

Section: Diskussionunclassified

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Toxisch epidermale Nekrolyse

Jäckel

Fuchs

Raff³

et al. 2002

Der Anaesthesist

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Toxic epidermal necrolysis (TEN) is a disease occurring with low-incidence but has a relatively high mortality rate. Sepsis is the predominant cause for life-threatening complications in TEN but severe mucosal damage represents a further complication which may delay convalescence. We report a case of TEN in a 51-year-old man which eventually spread to include the whole skin surface. The long-term and comprehensive treatment focused on support of the organ failure as well as wound treatment. The extent of involvement of the intestinal tract, the sustained laryngeal stenosis and the pronounced saddle-nose were unusual. It appears necessary to treat TEN in facilities which offer intensive care and are able to manage extensive skin damage. Burns units offer the best conditions for its management.

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Laryngeal involvement in toxic epidermal necrolysis

Cited by 13 publications

References 14 publications

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

Long-Term Consequences of Toxic Epidermal Necrolysis in Children

Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study

Toxisch epidermale Nekrolyse

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