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)
Yıl: 2014Cilt: 12Sayı: 2ISSN: 1304-9054 / 1308-6308Sayfa Aralığı: 116 - 122Türkçe

148 1
Toksik Epidermal Nekroliz Tedavisinde Siklosporin A Kullanımı; Olgu Sunumu ve Literatür Derlemesi
Toksik epidermal nekroliz (TEN) sıklıkla ilaçlar tarafından tetiklenen, deri, göz, mukozalar ve birden çok organı etkileyebilen, ciddi ve hayatı tehdit eden akut mukokütanöz bir hastalıktır. On bir yaşında kız hasta, epilepsi nedeni ile 3 yıldır valproik asit kullanırken tedavisine bir ay önce lamotrigin eklenmişti. Hasta iki gün önce başlayan ateş, halsizlik, ağız içinde yaralar, gözlerde kızarıklık, sulanma, deride döküntü ve çok sayıda büllöz lezyonlar ile başvurdu. Fizik muayenede, genel durumu kötü, tüm vücutta yaygın makülopapüler döküntüler, purpurik maküller, tipik olmayan hedef benzeri deri lezyonları, vücut yüzeyinin %30dan fazlasını etkileyen değişik evrelerde en büyüğü 6-10 cm çaplarında çok sayıda büller saptandı. Ağız mukozasında ülsere lezyonlar, her iki gözde keratit, blefarit ve konjunktival hiperemi vardı. Hastaya mevcut bulguları ile TEN tanısı konuldu. Lamotrigin tedavisi 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 hastanın tedavisine siklosporin A eklendi. Siklosporin A tedavisine iyi cevap alınan olgunun klinik tablo ve deri lezyonlarında belirgin iyileşme gözlendi. TEN tedavisinin esasını şüpheli ilacın kesilmesi ve destek tedavisi oluşturmaktadır. TEN tedavisinde, sistemik kortikosteroidler, İVİG gibi immünsüpresif ajanlar tedavide kullanılabilmektedir. Tedaviye dirençli veya ciddi TEN olgularında siklosporin kullanımı tedaviye olumlu katkı sağlayabilir. Siklosporinin TEN tedavisindeki yeri ve etkilerini araştırmaya yönelik ayrıntılı çalışmalara ihtiyaç vardır. (Gün cel Pe di at ri 2014;2:116-22)
Fen > Tıp > Dermatoloji
Fen > Tıp > Pediatri
Dergititle.paper.fact_presentationErişime Açık
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