Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review
Toxic epidermal necrolysis (TEN) is a rare and life-threatening severe cutaneous adverse reaction. The conventional treatment approach includes immunomodulatory therapies, such as systemic corticosteroids, cyclosporine, intravenous immunoglobulin (IVIG), and tumor necrosis factor-alpha (TNF-α) inhib...
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Frontiers Media S.A.
2025-05-01
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| Series: | Frontiers in Immunology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1579349/full |
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| author | Shun-Qi Liao Zhang-Rong Yan Lun-Wei Lin Ming Deng Guo-Jin Xiao Pei-Yang Gao |
| author_facet | Shun-Qi Liao Zhang-Rong Yan Lun-Wei Lin Ming Deng Guo-Jin Xiao Pei-Yang Gao |
| author_sort | Shun-Qi Liao |
| collection | DOAJ |
| description | Toxic epidermal necrolysis (TEN) is a rare and life-threatening severe cutaneous adverse reaction. The conventional treatment approach includes immunomodulatory therapies, such as systemic corticosteroids, cyclosporine, intravenous immunoglobulin (IVIG), and tumor necrosis factor-alpha (TNF-α) inhibitors. Plasmapheresis, as a potential treatment for TEN, is rarely used in patients with refractory TEN. We report a successful case of plasmapheresis treatment in a patient with refractory TEN who did not respond to conventional treatment, and we provide a literature review. A 65-year-old female presented with diffuse erythematous papules covering her entire body, along with multiple blisters and bullae, and partial detachment of the epidermis and mucosa. The area of epidermal exfoliation exceeded 30% of the total body surface area, and Nikolsky’s sign was positive. Despite a week of methylprednisolone treatment, numerous blisters and bullae developed, and the area of epidermal exfoliation expanded to 62%. IVIG and TNF-α inhibitors were subsequently added, but the disease remained uncontrolled. Plasmapheresis treatment was initiated. Epithelial regeneration was observed after three days of plasmapheresis. After plasmapheresis was given 5 times, the patient finally recovered. This case highlights the significance of plasmapheresis in the treatment of refractory TEN, particularly when conventional therapies are ineffective. More studies are needed in the future to confirm the efficacy of plasmapheresis treatment. |
| format | Article |
| id | doaj-art-ecc3dc98c6494a83a0679dd501af16b7 |
| institution | DOAJ |
| issn | 1664-3224 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Immunology |
| spelling | doaj-art-ecc3dc98c6494a83a0679dd501af16b72025-08-20T03:05:30ZengFrontiers Media S.A.Frontiers in Immunology1664-32242025-05-011610.3389/fimmu.2025.15793491579349Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature reviewShun-Qi Liao0Zhang-Rong Yan1Lun-Wei Lin2Ming Deng3Guo-Jin Xiao4Pei-Yang Gao5Department of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaDepartment of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaNursing Department, Luzhou Hospital of Traditional Chinese Medicine, Luzhou, ChinaDepartment of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaDepartment of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaDepartment of Critical Care Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, ChinaToxic epidermal necrolysis (TEN) is a rare and life-threatening severe cutaneous adverse reaction. The conventional treatment approach includes immunomodulatory therapies, such as systemic corticosteroids, cyclosporine, intravenous immunoglobulin (IVIG), and tumor necrosis factor-alpha (TNF-α) inhibitors. Plasmapheresis, as a potential treatment for TEN, is rarely used in patients with refractory TEN. We report a successful case of plasmapheresis treatment in a patient with refractory TEN who did not respond to conventional treatment, and we provide a literature review. A 65-year-old female presented with diffuse erythematous papules covering her entire body, along with multiple blisters and bullae, and partial detachment of the epidermis and mucosa. The area of epidermal exfoliation exceeded 30% of the total body surface area, and Nikolsky’s sign was positive. Despite a week of methylprednisolone treatment, numerous blisters and bullae developed, and the area of epidermal exfoliation expanded to 62%. IVIG and TNF-α inhibitors were subsequently added, but the disease remained uncontrolled. Plasmapheresis treatment was initiated. Epithelial regeneration was observed after three days of plasmapheresis. After plasmapheresis was given 5 times, the patient finally recovered. This case highlights the significance of plasmapheresis in the treatment of refractory TEN, particularly when conventional therapies are ineffective. More studies are needed in the future to confirm the efficacy of plasmapheresis treatment.https://www.frontiersin.org/articles/10.3389/fimmu.2025.1579349/fulltoxic epidermal necrolysisSteven Johnson syndromeplasmapheresissevere cutaneous adverse reactionrefractory |
| spellingShingle | Shun-Qi Liao Zhang-Rong Yan Lun-Wei Lin Ming Deng Guo-Jin Xiao Pei-Yang Gao Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review Frontiers in Immunology toxic epidermal necrolysis Steven Johnson syndrome plasmapheresis severe cutaneous adverse reaction refractory |
| title | Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review |
| title_full | Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review |
| title_fullStr | Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review |
| title_full_unstemmed | Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review |
| title_short | Plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy: a case report and literature review |
| title_sort | plasmapheresis for refractory toxic epidermal necrolysis unresponsive to conventional therapy a case report and literature review |
| topic | toxic epidermal necrolysis Steven Johnson syndrome plasmapheresis severe cutaneous adverse reaction refractory |
| url | https://www.frontiersin.org/articles/10.3389/fimmu.2025.1579349/full |
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