Summary
Intestinal involvement in toxic epidermal necrolysis (TEN) has been identified only rarely. This report describes a case of TEN with ileal manifestations characterized by a profuse diarrhea with malabsorption, protein-losing enteropathy, and radiologically by multiple stenosis. After healing of the cutaneous lesions, total parenteral nutrition was initiated, resulting in a decreased diarrhea. However, after one month of total parenteral nutrition, malabsorption and protein-losing enteropathy continued and the radiological lesions were still present with an aspect consistent with a sclerotic process. A surgical resection of the pathological ileal segment was performed with end-to-end anastomosis. Pathological examination of the resected segment showed a necrosis of the ileal mucosa with a pattern similar to that of the epidermal necrosis. No sclerosis was observed. It seems that a prolonged total parenteral nutrition could have induced a complete healing of intestinal lesions. This case report is the first clinical, radiological, and histological study of an ileal involvement in TEN.
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References
Lyell A: Toxic epidermal necrolysis (the scalded skin syndrome). Br J Dermatol 100:69–86, 1979
Roujeau JC, Chosidow O, Saiag P, Guillaume JC: Toxic epidermal necrolysis (Lyell syndrome). J Am Acad Dermatol 23:1039–1058, 1990
Roujeau JC, Guillaume JC, Fabre JP, Penso D, Flechet ML, Gibre JP: Toxic epidermal necrolysis (Lyell syndrome): Incidence and drug etiology in France, 1981–1985. Arch Dermatol 126:37–42, 1990
Werblowsky CN, Livshin R, Burtein M, Zeligowski A, Turkaspa R: Toxic epidermal necrolysis associated with acute cholestatic viral hepatitis. Am J Clin Gastroenterol 11:691–693, 1989
Revuz J, Penso D, Roujeau JC, Guillaume JC, Payne CR, Wechsler J, Touraine R: Toxic epidermal necrolysis: Clinical findings and prognosis factors in 87 patients. Arch Dermatol 123:1160–1165, 1987
Roupe G, Ahlmen M, Fagerberg B, Suurhula M: Toxic epidermal necrolysis with extensive mucosal erosions of the gastrointestinal and respiratory tracts. Int Arch Allerg Immunol 80:145–151, 1986
Herman TE, Kushner DC, Cleveland RH: Esophageal stricture secondary to drug-induced toxic epidermal necrolysis. Pediatr Radiol 14:439–440, 1984
Tagami H, Iwatsuki K: Elevated serum amylase in toxic epidermal necrolysis. Br J Dermatol 115:250–251, 1986
Heer M, Altorfer J, Burger HR, Walti M: Bullous esophageal lesions due to co-trimoxazole: An immune-mediated process? Gastroenterology 88:1954–1957, 1985
Delchier JC, Chosidow O, Chaumette NT, Blaquez M, Soulé JC, Roujeau JC, Revuz J: Atteinte intestinale au cours du syndrome de Lyell, à propos de 4 cas. Gastroenterol Clin Biol 15:A25, 1991
Zweiban B, Cohen H, Chandrasoma P: Gastrointestinal involvement complicating Stevens-Johnson syndrome. Gastroenterology 91:469–474, 1986
Bjarmasson I, Price AB, Zanelli G, Smethurst P, Gumpel JM, Zevi AJ: Clinicopathological features of non-steroidal anti-inflammatory drug-induced small intestinal structures. Gastroenterology 94:1070–1074, 1985
Morris AJ, Madhok R, Sturrock RD, Capell HA, Mackenzie JF: Enteroscopic diagnosis of the small bowel ulcerations in patients receiving non-steroidal anti-inflammatory drugs. Lancet 337:207, 1991
Kieni R, Enqalabre J, Greff D: Syndromes mésentériques aigus et chroniques.In Gastroenterologie. Flammarion (ed). Paris, 1986, pp 1362–1371
McDonald G, Shulman UM, Sullivan KM, Sencer GD: Intestinal and hepatic complication of human bone marrow transplantation, Part 1. Gastroenterology 90:460–477, 1986
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Michel, P., Joly, P., Ducrotte, P. et al. Ileal involvement in toxic epidermal necrolysis (Lyell syndrome). Digest Dis Sci 38, 1938–1941 (1993). https://doi.org/10.1007/BF01296123
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DOI: https://doi.org/10.1007/BF01296123