martes, 17 de febrero de 2009

7.-TOXIC EPIDERMAL NECROLYSIS FATAL RELATED TO PHENITOYN ADMINISTRATION.PROF.GARFIA.A

7.-TOXIC EPIDERMAL NECROLYSIS FATAL AND PHENITOYN.
PROF.GARFIA.A

CASE REPORT

     Untowards reactions to drugs are an important medical problem, sometimes followed by a fatal outcome. Although drugs reactions may involve any organ system, cutaneous eruptions drug-induced may result from a drug administered by any route, which reactions can be identified more frequently than other toxics drug-depending effects which occurs in other organs, such as liver and kidney, because their visibility.Toxic epidermal necrolysis (TEN) or Lyell's Syndrome, is one of the most dramatic, the most severe, and one of most often studied cutaneous drug reactions. TEN is characterized by extensive detachment of the epidermis nuder-going full-thickness necrosis.     The drugs more frequently implicated are: anticonvulsivants (phenitoyn, phenobarbital, carbamazepine);antibiotics (ampicillin), sulfonamides and nonsteroids antiinflamatory agents (phenylobutazone, oxyphenbutazone, isoxicam, piroxicam and allopurinol).

We report here a fatal case of TEN related to the anticonvulsivant drug phenitoyn, which was prescribed a man, 74 years old, one month before in order to treat a temporal epilepsy, secondary to a stroke (residual epilepsy).


PROF. GARFIA.A
BLOG 7
FORENSICPATHOLOGYFORUM
FIG.1.-A.-To show a diffuse macular and papular erythematous eruption that rapidly becomes confluent and widespread followed by flaccid fluid filled bullae (B) which rapidly ulcerate, leaving painful raw erosions similar to scalding. Mild pressure on erythematous areas may produce (C) detachment of the epidermis (positive Nikolsky sign) and aspect of wet cloth of the epidermis. As result, there may be large areas of exposed dermis resembling a burn (C). Prof.Garfia.A


PROF. GARFIA.A
BLOG 7
FORENSICPATHOLOGYFORUM

FIG. 2 .- The histopathological features of early lesions of toxic epidermal necrolysis are those of an extreme degree of epidermal keratinocyte necrosis (2A), associated with subepidermal blistering (2B, arrows), as a consecuence of basal cell hydropic degeneration. 
In more mature lesion, there is complete separation of the epidermis (2C) and the roof of the subepidermal bulla is, usually, necrotic. 
2C.-Showing necrotic epidermis completely separated from underlying dermis and to note the paucity of dermal inflamatory infiltrate. Prof.Garfia.A