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Treatment of toxic epidermal necrolysis with intravenous immunoglobulin: a series of three cases

Tratamento da necrólise epidérmica tóxica com imunoglobulina endovenosa: uma série de três casos

Cristiane Comparin Günter Hans Filho Luiz Carlos Takita Nayara de Castro Wiziack Costa Roberta Ayres Ferreira do Nascimento Lidiane de Oliveira Costa Nanni About the authors

Stevens-Johnson's syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening dermatoses, that lead to keratinocyte apoptosis induced by interactions between Fas (cell death receptor) and soluble Fas-ligand, present in serum of Stevens-Johnson's syndrome / toxic epidermal necrolysis patients. Anti-Fas antibodies in intravenous immunoglobulin (IVIG) would block the apoptosis cascade. Three cases of toxic epidermal necrolysis occurred in one male and two female patients, after use of allopurinol, leprosy multidrug therapy concomitant with dipyrone, and diclofenac. The cases were treated with intravenous immunoglobulin 2-3 mg/kg and prednisone 20-50 mg/day. The interruption of new lesions outbreak and reepithelization were extremely fast after the use of intravenous immunoglobulin, without adverse effects. Controlled studies are needed to confirm the efficacy of intravenous immunoglobulin in Stevens-Johnson's syndrome / toxic epidermal necrolysis, but the results seem promising.

drug toxicity; epidermal necrolysis, toxic; fas ligand protein; immunoglobulins, intravenous

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