Toxic Epidermal Necrolysis: Treatment of Two Cases with Intravenous Immunoglobulin,Sore Mouth Infection

Toxic epidermal necrolysis (TEN) is a severe allergic reaction, often to drugs, with an approximate 30-40% mortality. Discontinuation of the offending drug and burn unit supportive care are agreed upon as initial therapy. However, use of Intravenous Immunoglobulin (IVIG) has been shown effective but controversial. We report 2 cases of TEN treated with IVIG for 5 days and burn unit intensive care therapy. One case had early adjunctive systemic corticosteroid therapy; the other case had no systemic steroids. Both cases demonstrated a severity of illness score for TEN (SCORTEN) at day 1 of 35.3% and day 3 of 58.3%. Previous reports base their opinion regarding IVIG effectiveness on studies that do not uniformly specify these treatment details or wherein IVIG treatment protocol was for less than 5 days. Inclusion of this data and use of this treatment protocol may demonstrate significantly improved outcomes in TEN patients treated with IVIG.