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An event is serious (based on the ICH definition) when the patient outcome is:
* death
* life-threatening
* hospitalisation
* disability
* congenital anomaly
* other medically important event
A 62-year-old man developed toxic epidermal necrolysis (TEN) following treatment with allopurinol, cotrimoxazole and lenalidomide [routes, dosages and duration of treatments to reaction onset not stated].
The man presented with tender, erythematous maculopapular eruption and targetoid lesions on the palms and soles. He had undergone stem cell transplantation in 2008 and he also had multiple myeloma. Six weeks prior to this presentation, he was started on allopurinol, cotrimoxazole [Septrin] and lenalidomide, and for suspected lower respiratory tract infection, he had been receiving amoxicillin. At current presentation, his rash evolved into large areas of flaccid blistering with mucosal involvement and it occupied almost 30% of the body surface area. Laboratory tests showed CRP level 55 mg/L, D-dimer level 2218 ng/L, neutrophil count 2.3×109/L, ferritin level 240 µg/L and lymphocyte count 0.5×109/L. From skin biopsy studies, a diagnosis of TEN was made. His SCORTEN score was 3. Simultaneously, he also tested positive for COVID-19.
The man's allopurinol, cotrimoxazole and lenalidomide were stopped, and he was treated with supportive therapy using IV immunoglobulin 2 g/kg for 3 days (for both TEN and COVID-19). The immunoglobulin therapy was off-label for COVID-19. Subsequently, his TEN improved and no further progression of COVID-19 was noted.
Reference
- Saha M, et al. Toxic epidermal necrolysis and co-existent SARS-CoV-2 (COVID-19) treated with Intravenous Immunoglobulin: "Killing 2 birds with one stone". Journal of the European Academy of Dermatology and Venereology : 17 Aug 2020. Available from: URL: 10.1111/jdv.16887 [DOI] [PMC free article] [PubMed]