Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi

Cekic, Sukru; Sapan, Nihat; CANITEZ, Yakup

Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi

Yakup CANITEZ, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Allerji Bilim Dalı, Bursa, Türkiye)

Şükrü ÇEKİÇ, (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Allerji Bilim Dalı, Bursa, Türkiye)

Nihat SAPAN (Uludağ Üniversitesi, Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Allerji Bilim Dalı, Bursa, Türkiye)

Güncel Pediatri

7 1

Yıl: 2014 Cilt: 12 Sayı: 2 Sayfa Aralığı: 116 - 122 Metin Dili: Türkçe İndeks Tarihi: 29-07-2022

Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi

Öz:

Toksik epidermal nekroliz (TEN) sıklıkla ilaçlar tarafından tetiklenen, deri, göz,mukozalar ve birden çok organı etkileyebilen, ciddi ve hayatı tehdit eden akutmukokütanöz bir hastalıktır.On bir yaşında kız hasta, epilepsi nedeni ile 3 yıldır valproik asit kullanırkentedavisine bir ay önce lamotrigin eklenmişti. Hasta iki gün önce başlayan ateş,halsizlik, ağız içinde yaralar, gözlerde kızarıklık, sulanma, deride döküntü veçok sayıda büllöz lezyonlar ile başvurdu. Fizik muayenede, genel durumu kötü,tüm vücutta yaygın makülopapüler döküntüler, purpurik maküller, tipik olmayanhedef benzeri deri lezyonları, vücut yüzeyinin %30dan fazlasını etkileyendeğişik evrelerde en büyüğü 6-10 cm çaplarında çok sayıda büller saptandı. Ağızmukozasında ülsere lezyonlar, her iki gözde keratit, blefarit ve konjunktivalhiperemi vardı. Hastaya mevcut bulguları ile TEN tanısı konuldu. Lamotrigintedavisi kesildi, destek tedavisi, metilprednisolon, intravenöz immunglobulin,deri ve göz lezyonlarına yönelik bakım ve gerekli topikal tedaviler uygulandı.İzleminde klinik tablo ve deri lezyonlarında iyileşme olmaması üzerine hastanıntedavisine siklosporin A eklendi. Siklosporin A tedavisine iyi cevap alınan olgununklinik tablo ve deri lezyonlarında belirgin iyileşme gözlendi. TEN tedavisinin esasını şüpheli ilacın kesilmesi ve destek tedavisi oluşturmaktadır.TEN tedavisinde, sistemik kortikosteroidler, İVİG gibi immünsüpresif ajanlartedavide kullanılabilmektedir. Tedaviye dirençli veya ciddi TEN olgularındasiklosporin kullanımı tedaviye olumlu katkı sağlayabilir. Siklosporinin TENtedavisindeki yeri ve etkilerini araştırmaya yönelik ayrıntılı çalışmalara ihtiyaçvardır. (Gün cel Pe di at ri 2014;2:116-22)

Anahtar Kelime:

Konular: Dermatoloji Pediatri

The Use of Cyclosporine A in the Treatment of Toxic Epidermal Necrolysis; Case Report and Review of Literature

Öz:

Toxic epidermal necrolysis (TEN) is a serious and life-threatening acutemucocutaneous disease that is often triggered by drugs, can affect skin, eyes,mucous membranes and multiple organs.While an eleven-year-old female patient with epilepsy had been using valproic acidfor three years, lamotrigine was added to the treatment one month ago. The patientwas admitted complaints such as fever, malaise, sores in the mouth, eye redness,watering of eyes, rashes and many bullous lesions in the skin that had started just2 days earlier. On the physical examination, whose overall situation was bad, thatwere common maculopapular rash, purpuric macules on the whole body, atypicaltarget-like skin lesions, and many bullae that affected more than 30% of the bodyin different stages and whose largest one was 6-10 cm in diameter were detected.There were ulcerated lesions in the oral mucosa and keratitis, blepharitis andconjunctival hyperemia in both eyes. The patient was diagnosed with TEN throughthe existing findings. The lamotrigine treatment was discontinued; the supportivetreatment, methylprednisolone, intravenous immunoglobulin, necessary care forskin and eye lesions and the necessary topical treatment were applied. As no improvement was observed in clinical picture and skinlesions in the follow-up period, cyclosporine A was added to the treatment. Significant improvement was observed in the clinicalpicture and skin lesions of the patient who responded well to the treatment of cyclosporine A. The basis of the treatment of TEN is composed of discontinuation of the suspicious drug and the supportive therapy. Theimmunosuppressive agents such as systemic corticosteroids and IVIG therapy may be used in the treatment of TEN. Cyclosporinecan positively contribute to the treatment in cases who are resistant to treatment and with a severe TEN condition. There is a needfor in-depth studies to investigate the place and impact of cyclosporine in the treatment of TEN. (The Jo ur nal of Cur rent Pe di at rics2014;2:116-22)

Anahtar Kelime:

Konular: Dermatoloji Pediatri

Belge Türü: Makale Makale Türü: Olgu Sunumu Erişim Türü: Erişime Açık

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APA	CANITEZ Y, Cekic S, Sapan N (2014). Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. , 116 - 122.
Chicago	CANITEZ Yakup,Cekic Sukru,Sapan Nihat Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. (2014): 116 - 122.
MLA	CANITEZ Yakup,Cekic Sukru,Sapan Nihat Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. , 2014, ss.116 - 122.
AMA	CANITEZ Y,Cekic S,Sapan N Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. . 2014; 116 - 122.
Vancouver	CANITEZ Y,Cekic S,Sapan N Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. . 2014; 116 - 122.
IEEE	CANITEZ Y,Cekic S,Sapan N "Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi." , ss.116 - 122, 2014.
ISNAD	CANITEZ, Yakup vd. "Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi". (2014), 116-122.

APA	CANITEZ Y, Cekic S, Sapan N (2014). Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. Güncel Pediatri, 12(2), 116 - 122.
Chicago	CANITEZ Yakup,Cekic Sukru,Sapan Nihat Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. Güncel Pediatri 12, no.2 (2014): 116 - 122.
MLA	CANITEZ Yakup,Cekic Sukru,Sapan Nihat Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. Güncel Pediatri, vol.12, no.2, 2014, ss.116 - 122.
AMA	CANITEZ Y,Cekic S,Sapan N Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. Güncel Pediatri. 2014; 12(2): 116 - 122.
Vancouver	CANITEZ Y,Cekic S,Sapan N Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi. Güncel Pediatri. 2014; 12(2): 116 - 122.
IEEE	CANITEZ Y,Cekic S,Sapan N "Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi." Güncel Pediatri, 12, ss.116 - 122, 2014.
ISNAD	CANITEZ, Yakup vd. "Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi". Güncel Pediatri 12/2 (2014), 116-122.