Two cases of toxic epidermal necrolysis treated with plasma exchange

Abstract

We report two cases of toxic epidermal necrolysis (TEN) treated with plasma exchange. Case 1 is a Japanese woman in her 50s who developed TEN after oral intake of several drugs for common cold-like symptoms. Case 2 is a Japanese man in his 60s who developed TEN after having used multiple drugs for acute myocardial infarction. Because erosions and excoriations progressed after the initial treatment with steroid pulse therapy in these cases, we performed plasma exchange. In both cases, epithelialization began several days after the initiation of plasma exchange. However, case 2 died from acute cardiac insufficiency. Recently, apoptosis of keratinocytes by Fas/FasL has been proposed as a pathogenetic mechanism of TEN. Effectiveness of plasma exchange when there is no rise in sFasL in the patient's serum before treatment suggests that some other factors may play important roles in the development and progression of TEN.