A Case of Cefoperazone/Sulbactam Induced Toxic Epidermal Necrolysis in a
Middle Aged Egyptian Female.
Abstract
Background: Toxic Epidermal Necrolysis (TEN) is a rare, drug induced
life-threatening mucocutaneous condition caused by immune system
activation. TEN is associated with widespread keratinocyte death causing
full-thickness denudation of the skin and mucosa, resulting in sepsis
and a mortality rate of 30%. Case Description: A 32-year-old female
patient was precribed cefoperazone/sulbactam for sore throat. One day
later she experienced an itchy rash on her hands. She was given IM
dexamethazone for 4 days with no improvement. She presented to the
emergency department 6 days later with severe itchy rash. On
examination, there was a generalized symmetrical, desquamating
erythematous rash distributed on the face, chest and back, with buccal
ulceration and violaceous discoloration of the hands and feet. Vital
signs were normal. Routine laboratory investigations were significant
for high C-reactive protein and low serum albumin. Serology for HIV was
negative. A diagnosis of cefoperazone/sulbactam-induced-TEN was made and
the drug was discontinued. Evaluation of the SCORE of TEN (SCORTEN) on
day one was 1. The patient was admitted to the intensive care unit where
she received supportive treatment and intravenous immunoglobulin (IVIG)
at a dose of 2 gm/kg over 5 days with gradual improvement. Discussion:
Cefoperazone/Sulbactam-induced-TEN is an idiosyncratic, dose independent
adverse event. IvIG was used 7 days after appearance of the desquamation
with considerable recovery. Keywords: Cefoperazone/Sulbactam Stevens -
Johnson syndrome, Toxic Epidermal Necrolysis.