Toxic Epidermal Necrolysis with Involvement of the Gastrointestinal and Respiratory Tracts

Toxic epidermal necrolysis (TEN) is a severe dermatologiocal disorder characterized by extended epidermal necrosis. Intestinal involvement in toxic epidermal necrolysis has been identified only rarely. We report a case of TEN with mucosal erosions of the gastrointestinal and respiratory tracts. A 38-year-old woman was hospitalized with high fever, severe diarrhea and skin eruption. Bloody stool appeared on the day of admission. Skin eruptions extended over 38% of the body surface area by the 4th hospital day. Histological examination of a cutaneous biopsy confirmed the diagnosis of TEN. Sudden cardiac arrest occurred after tachypnea on the 6th hospital day. After heart beat was restored, bronchoscopy revealed bronchial obstruction due to respiratory mucosal sloughing. Despite intensive care, she died from sepsis on the 45th hospital day. Bacterial translocation might have occurred from the gastrointestinal lesions. Autopsy revealed extensive intestinal erosion and ulcer with respiratory tract erosions. We concluded that gastrointestinal and bronchial involvements might contribute to the increased mortality of TEN patients.