Skin rash in the intensive care unit: Stevens‑johnson syndrome, toxic epidermal necrolysis, or a rare manifestation of a hidden cutaneous malignancy: A case report
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- Published online on: December 16, 2015 https://doi.org/10.3892/mco.2015.713
- Pages: 413-415
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Abstract
Skin rashes are infrequently encountered in the intensive care units, either as a result or as a cause of admission. The entities of Stevens‑Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) form a spectrum of desquamating skin diseases that have multiple etiologies, the most common being drug‑related reactions; very rarely, the cause may be cutaneous malignancies. We herein present a unique case of a 54‑year‑old male patient with psoriasis treated with methotrexate, who presented with a cellulitis‑like clinical picture, then developed a severe progressive systemic inflammatory response syndrome, and progressed clinically to SJS, then TEN even after discontinuing the antibiotics and methotrexate. A skin biopsy demonstrated an aggressive and rapidly‑progressing T‑cell lymphoma. The present case highlights the necessity of skin biopsy when encountering SJS and TEN in the ICU in order to identify potentially treatable/controllable causes. Although it appeared reasonable to correlate TEN solely to medications, the skin biopsies clearly demonstrated an aggressive T‑cell skin lymphoma. In a patient with a better general condition it may have been helpful to treat this malignancy. TEN is a life‑threatening condition and skin biopsy is the cornerstone of diagnosis, despite the presence of multiple risk factors and the typical physical findings of a drug‑induced reaction.
