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    • br Results Three cases were diagnosed as TEN associated with

    2018-11-06


    Results Three cases were diagnosed as TEN associated with M. pneumoniae and two were diagnosed as TEN associated with herpes simplex virus infection (Table 2). The presence of these viruses was confirmed by positive serologic findings. The patients consisted of three boys and two girls, with an average age of 8.6 years (range 6–12 years). All cases were referred to the BICU at the acute stage with an average duration from disease onset of 4.2 ± 3.1 days. The average rate of TBSA epidermal detachment among our patients was 55 ± 30.7%. The average SCORTEN score recorded on admission was 1. All patients survived. The average hospital stay of survived patients was 16.2 days (range 10–24 days). According to our database, there were 62 patients with drug-induced TEN. A younger age (infection-induced TEN:drug-induced TEN = 8.6:61.8, p < 0.05); lower SCORTEN score (infection-induced TEN:drug-induced TEN = 1: 3.0, p < 0.05); less renal dysfunction (infection-induced TEN:drug-induced TEN = 0%:32.3%, p < 0.05); shorter hospitalization AZD-9291 manufacturer (infection-induced TEN:drug-induced TEN = 16.2:22.1, p < 0.05); and higher survival rate (infection-induced TEN:drug-induced TEN = 100%:48.4%, p < 0.05) were noted in patients with infection-induced TEN (Table 3). Infection-induced TEN manifests a less severe clinical course than its drug-induced counterpart.
    Discussion TEN is a rare but life-threatening disorder, with an incidence estimated at 0.4–1.3 cases per million person-years. TEN is an acute condition that often results from an adverse drug reaction. The drugs linked to the majority of patients with TEN include anticonvulsants, nonsteroidal anti-inflammatory drugs, allopurinol, and some antibiotics. However, other conditions, such as infections, can also act as a trigger. In previous studies, several viral infections have been reported to be associated with TEN, such as the Epstein–Barr virus, cytomegalovirus, human herpes virus-6, herpes simplex virus, and human immunodeficiency virus. According to the literature, most skin reactions caused by M. pneumoniae and herpes simplex virus infections are associated with less frequent and less severe complications than those with other causes. The outcome and prognosis are typically favorable with no permanent complications. In this study, three cases were due to M. pneumoniae, and two were due to a herpes simplex virus infection, as confirmed by a positive serologic finding. We found that the five patients with infection-induced TEN were younger in age and had lower SCORTEN scores, less renal dysfunction, shorter hospitalization periods, and higher survival rates compared with patients with drug-induced TEN. According to our results, TEN in adults is typically caused by a drug, whereas TEN in children is typically caused by an infection. The mean age of those with infection-related TEN was 8.6 ± 1.9 years, whereas the mean age of those with drug- induced TEN was 61.8 ± 19.8 years. Older age was one risk factor for a poor prognosis. Roujeau et al reported patients older than 40 years had a greater risk of death because of higher rates of underlying disease and immunodeficiency. The average SCORTEN score for patients with infection-induced TEN was 1. The predicted mortality rate by SCORTEN score was 3.2%. The actual mortality rate in our series was 0%. No permanent complications were noted. No renal dysfunction was found in the patients with infection-induced TEN; however, a 32.3% rate of renal dysfunction was noted in the patients with drug-induced TEN. The higher mortality rate among the patients with drug-induced TEN may be attributable to a higher rate of renal failure compared with those with infection-induced TEN. The aforementioned higher rates of renal failure are likely a result of the tendency in Chinese society to use Chinese medication or herbs or multiple drugs instead of seeking medical assistance. This tendency can compound problems, substantially impair renal function, and deteriorate a patient\'s general condition. In our previous study, we observed that kidney dysfunction is one of the most crucial factors affecting outcome in patients with TEN. A higher renal dysfunction rate is a likely explanation for lower survival rates among patients with drug-induced TEN compared with those with infection-induced TEN.