Clinical study on toxic epidermal necrolysis in 11 children
10.3760/cma.j.issn.1673-4912.2023.09.003
- VernacularTitle:儿童中毒性表皮坏死松解症11例临床研究
- Author:
Yanqiang DU
1
;
Hua ZHANG
;
Yi WANG
;
Zhangyan GUO
Author Information
1. 国家儿童区域医疗中心（西北） 西安交通大学附属儿童医院 西安市儿童医院儿童重症医学科 710003
- Keywords:
Children;
Therapeutic plasma exchange;
Toxic epidermal necrolysis;
Corticosteroid;
Intravenous immune globulin
- From:
Chinese Pediatric Emergency Medicine
2023;30(9):653-659
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the clinical characteristics and treatment strategies of toxic epidermal necrolysis(TEN) in children.Methods:The clinical data, laboratory examination, diagnosis and treatment process and treatment outcomes of 11 children with TEN treated in PICU at Children′s Hospital of Xi′an Jiaotong University from January 2018 to June 2022 were collected and analyzed retrospectively.Results:There were five males and six females, aged from one year to 11 years old.Nine cases were caused by drugs, among which six cases were caused by antiepileptic drugs, two cases were caused by Chinese patent medicine, one case was caused by antibiotics, and the remaining two cases were caused by infection.In addition to large area of skin exfoliation, one case was complicated with corneal perforation, one case was complicated with finger (toe) nail fall off, and two cases were complicated with upper airway obstruction.All children were complicated with various degrees of heart, liver, kidney and other organ damage.Eight cases who were admitted to the department of immunology were treated with methylprednisolone and intravenous immune globulin.Three cases had no change in rash, and five cases had an enlarged range of skin lesions compared with admission, and finally all of them were transferred to PICU.Three cases were first diagnosed in PICU and were not treated with methylprednisolone and intravenous immune globulin after admission.All 11 children were given therapeutic plasma exchange in PICU.For children whose first department was PICU, the average hospitalization time of PICU was (8.00±3.00) days, the total average hospitalization time was (33.66±20.10) days, and the average hospitalization cost was (73.9±30.5) thousand yuan.For children whose first department was the immunology department, the average hospitalization time of PICU was (21.62±16.18) days, the total average hospitalization time was (41.87±16.97) days, and the average hospitalization cost was (130.8±52.2) thousand yuan.One case, because of corneal perforation, the family members asked to leave the hospital for economic reasons after the rash improved, and the rest of the children were cured and discharged.Conclusion:TEN is rare, often complicated with multiple organ dysfunction, and has a high mortality.Early administration of therapeutic plasma exchange may alleviate multiple system damage and shorten the duration of disease.
