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Toxic epidermal necrolysis and hemophagocytic lymphohistiocytosis: a case report and literature review.

Sniderman JD, Cuvelier GD, Veroukis S, Hansen G - Clin Case Rep (2014)

Bottom Line: Diagnostic criteria for hemophagocytic lymphohistiocytosis should be reviewed early in critically ill patients with toxic epidermal necrolysis, multisystem dysfunction, and a deteriorating clinical trajectory.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics and Child Health, University of Manitoba Winnipeg, Manitoba, Canada.

ABSTRACT
Diagnostic criteria for hemophagocytic lymphohistiocytosis should be reviewed early in critically ill patients with toxic epidermal necrolysis, multisystem dysfunction, and a deteriorating clinical trajectory.

No MeSH data available.


Related in: MedlinePlus

(A) Evolving maculopapular rash prior to desquamation; (B) Upper chest skin biopsy showing completely detached epidermis and full epidermal necrosis; (C) Bone marrow aspirate demonstrating monocytes engulfing red blood cell precursors. (Giemsa stain).
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fig01: (A) Evolving maculopapular rash prior to desquamation; (B) Upper chest skin biopsy showing completely detached epidermis and full epidermal necrosis; (C) Bone marrow aspirate demonstrating monocytes engulfing red blood cell precursors. (Giemsa stain).

Mentions: Nine days after discharge the patient presented to the emergency department with a 5-day history of a spreading erythematous rash (Fig.1A) and 3 days of high fevers. Examination revealed a toxic, febrile and drooling toddler, with an extensive maculopapular rash, oral mucositis and biphasic stridor. Hepatosplenomegaly was not initially present. Computed tomography scanning demonstrated significant narrowing of the trachea and extensive lymphadenopathy throughout the neck. Laboratory investigation revealed increased aspartate aminotransferase (1179 U/L), alanine aminotransferase (1042 U/L), and lactate dehydrogenase (1203 U/L) levels, but normal total and direct bilirubin (6 and 5 μmol/L), gamma-glutamyl transferase (60 U/L) and alkaline phosphatase (143 U/L). Initial complete blood count revealed a normal total white blood cell count (8.7 × 109/L), normal neutrophil count (6.13 × 109/L), normal platelet count (161 × 109/L), and a mild normochromic normocytic anemia (hemoglobin 108 g/L). Cefotaxime, vancomycin, acyclovir, and high-dose methylprednisolone (4 mg/kg per day) were initiated and reintubation was required for airway protection.


Toxic epidermal necrolysis and hemophagocytic lymphohistiocytosis: a case report and literature review.

Sniderman JD, Cuvelier GD, Veroukis S, Hansen G - Clin Case Rep (2014)

(A) Evolving maculopapular rash prior to desquamation; (B) Upper chest skin biopsy showing completely detached epidermis and full epidermal necrosis; (C) Bone marrow aspirate demonstrating monocytes engulfing red blood cell precursors. (Giemsa stain).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4352368&req=5

fig01: (A) Evolving maculopapular rash prior to desquamation; (B) Upper chest skin biopsy showing completely detached epidermis and full epidermal necrosis; (C) Bone marrow aspirate demonstrating monocytes engulfing red blood cell precursors. (Giemsa stain).
Mentions: Nine days after discharge the patient presented to the emergency department with a 5-day history of a spreading erythematous rash (Fig.1A) and 3 days of high fevers. Examination revealed a toxic, febrile and drooling toddler, with an extensive maculopapular rash, oral mucositis and biphasic stridor. Hepatosplenomegaly was not initially present. Computed tomography scanning demonstrated significant narrowing of the trachea and extensive lymphadenopathy throughout the neck. Laboratory investigation revealed increased aspartate aminotransferase (1179 U/L), alanine aminotransferase (1042 U/L), and lactate dehydrogenase (1203 U/L) levels, but normal total and direct bilirubin (6 and 5 μmol/L), gamma-glutamyl transferase (60 U/L) and alkaline phosphatase (143 U/L). Initial complete blood count revealed a normal total white blood cell count (8.7 × 109/L), normal neutrophil count (6.13 × 109/L), normal platelet count (161 × 109/L), and a mild normochromic normocytic anemia (hemoglobin 108 g/L). Cefotaxime, vancomycin, acyclovir, and high-dose methylprednisolone (4 mg/kg per day) were initiated and reintubation was required for airway protection.

Bottom Line: Diagnostic criteria for hemophagocytic lymphohistiocytosis should be reviewed early in critically ill patients with toxic epidermal necrolysis, multisystem dysfunction, and a deteriorating clinical trajectory.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatrics and Child Health, University of Manitoba Winnipeg, Manitoba, Canada.

ABSTRACT
Diagnostic criteria for hemophagocytic lymphohistiocytosis should be reviewed early in critically ill patients with toxic epidermal necrolysis, multisystem dysfunction, and a deteriorating clinical trajectory.

No MeSH data available.


Related in: MedlinePlus