All issues > Volume 42(11); 1999

Case Report

J Korean Pediatr Soc. 1999;42(11):1594-1598. Published online November 15, 1999.

A Case of Toxic Epidermal Necrolysis in Early Infancy

Min Seong MS Kim¹, Jeong Nyun JN Kim¹, Bang Soon BS Kim², Hong Joo HJ Kim³, Myung Jae MJ Chey¹, Churl Young CY Chung¹

¹Departments of Pediatrics, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
²Departments of Dermatology, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea
³Departments of General Surgery, Inje University College of Medicine, Sanggye Paik Hospital, Seoul, Korea

Correspondence Jeong Nyun JN Kim ,Email: 1

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.

Keywords :Toxic epidermal necrolysis, Short bowel syndrome, Total parenteral nutrition, Stapyhlococcus aureus, Pseudomonas aeruginosa