J Korean Pediatr Soc.  1999 Nov;42(11):1594-1598.

A Case of Toxic Epidermal Necrolysis in Early Infancy

• Kim MS
• Kim JN
• Kim BS
• Kim HJ
• Chey MJ
• Chung CY

Abstract

Toxic epidermal necrolysis(TEN) is a bullous disorder affecting mainly basal layers of epidermis by hypersensitive reaction. It is rarely reported in infants under six months of age. It can be developed by drug, infection, and vaccination, which makes it difficult to differentiate from staphylococcal scalded skin syndrome(SSSS) especially in early infancy. We report a case of TEN in a 6-week-old infant with short bowel syndrome receiving total parenteral nutrition. A male infant(birth weight 2,570gm at 37 weeks) whose mother had polyhydramnios with bilous vomiting at birth was evaluated. Barium and histologic study showed total aganglionosis. Surgical resection was performed at 3 days of life and subsequently short bowel syndrome developed. Total parenteral nutrition via central venous catheter was done due to feeding intolerance. Staphylococcus aureus was cultured from blood at 37days of life, and we administered vancomycin. As multiple scaly eruption and fever developed at 47days of life, we were suspicious of SSSS. Blood culture done at 47days of life revealed Pseudomonas aeruginosa and skin biopsy showed the split at dermoepidermal junction at light microcopy and confirmed the diagnosis of TEN. Despite discontinuation of antibiotics, the infant did not improve and died due to shock at 54days of life. We emphasized that in case of acute, severe exfoliative disease in early infancy, the diagnosis of TEN should be considered and that skin biopsy should be performed to make the correct diagnosis.

Keyword

Toxic epidermal necrolysis; Short bowel syndrome; Total parenteral nutrition; Stapyhlococcus aureus; Pseudomonas aeruginosa

MeSH Terms

Anti-Bacterial Agents
Barium
Biopsy
Central Venous Catheters
Diagnosis
Epidermis
Fever
Humans
Infant
Male
Mothers
Parenteral Nutrition, Total
Parturition
Polyhydramnios
Pseudomonas aeruginosa
Shock
Short Bowel Syndrome
Skin
Staphylococcus aureus
Stevens-Johnson Syndrome*
Vaccination
Vancomycin
Vomiting
Anti-Bacterial Agents
Barium
Vancomycin