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A Case of Toxic Epidermal Necrolysis in Early Infancy

Journal of the Korean Pediatric Society 1999;42(11):1594-1598.
Published online November 15, 1999.
A Case of Toxic Epidermal Necrolysis in Early Infancy
Min Seong Kim1, Jeong Nyun Kim1, Bang Soon Kim2, Hong Joo Kim3, Myung Jae Chey1, Churl Young 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
영아기 초기에 발생한 독성 표피 융해성 괴사증 1례
김민성1, 김정년1, 김방순2, 김홍주3, 최명재1, 정철영1
1인제대학교 의과대학 상계백병원 소아과
2인제대학교 의과대학 상계백병원 피부과
3인제대학교 의과대학 상계백병원 일반외과
Correspondence: 
Jeong Nyun 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.
Key Words: Toxic epidermal necrolysis, Short bowel syndrome, Total parenteral nutrition, Stapyhlococcus aureus, Pseudomonas aeruginosa


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