Etanercept associated with pulse therapy with corticosteroids in toxic epidermal necrolysis: case report

Anelyse Pulner-Agulham, Department of Medicine, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brazil Claudio L. Franck, Department of Intensive Medicine, Hospital Universitário Evangélico Mackenzie, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brazil Beatriz Alvarez-Mattar, Department of Intensive Medicine, Hospital Universitário Evangélico Mackenzie, Faculdade Evangélica Mackenzie do Paraná, Curitiba, Paraná, Brazil Amanda S. Tiodózio, Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, Paraná, Brazil Lincoln H. Z. Fabricio, Department of Dermatology, Hospital Universitário Evangélico Mackenzie, Curitiba, Paraná, Brazil

Toxic epidermal necrolysis (TEN) is a rare dermatological disease characterized by desquamation of the epidermis on more than 30% of the body surface, which occurs days or weeks after the use of a medication or the causative disease. This report is about a case of TEN related to the use of allopurinol in a 61-year-old female patient admitted to a burn intensive care unit, in which she received multidisciplinary care. There are several treatment options; however, there is no gold standard. In this paper, the patient was treated primarily with corticosteroid pulse therapy, and then, with the administration of etanercept, there was a significant and rapid improvement in the lesions. This drug reduces mortality and reduces the time for re-epithelialization. Although etanercept is a promising treatment, as a monotherapy and in combination therapy, high-level evidence is still needed to support its routine use.

Keywords: Drug-related side effects and adverse reactions. Etanercept. Stevens–Johnson syndrome.