Toxic epidermal necrosis associated with mesalamine in a patient with ulcerative colitis

✍ Scribed by Ken Fukunaga; Yoshio Ohda; Taku Inoue; Tomoaki Kono; Hiroto Miwa; Takayuki Matsumoto

• Publisher: John Wiley and Sons
• Year: 2007
• Tongue: English
• Weight: 101 KB
• Volume: 13
• Category: Article
• ISSN: 1078-0998
• DOI: 10.1002/ibd.20125

✦ Synopsis

On 20 July 2006 a 17-year-old male was admitted to our critical care unit for the treatment of painful eruptions on his trunk, resembling toxic epidermal necrosis (TEN). On 13 June 2006 he had been diagnosed with ulcerative colitis (UC) and was hospitalized on 28 June 2006 for treatment of an acute UC flare. On 16 July 2006 dorsolumbar purpura had suddenly appeared during treatment with 2250 mg/ day oral mesalamine (Pentasa; Ferring Pharmaceuticals, Lausanne, Switzerland) and 1.5 mg/kg/day intravenous methylprednisolone (PSL). Liver and renal dysfunction, mild thrombocytopenia, together with cutaneous eruptions were confirmed in our institution. The patient was feverish (39°C) on arrival and complained of cutaneous pain severe enough to be given morphine. Laboratory tests showed leucocytosis (WBC 137.6 ϫ 10 3 /L), moderate thrombocytopenia (PLT 90.7 ϫ 10 3 /L), elevated serum C-reactive protein (CRP 4.4 mg/ dL), aspartate aminotransferase (AST 52UI/L), alanine aminotransferase (ALT 279UI/L), alkaline phosphatase (ALP 1023UI/L), gamma-glutamyl transpeptidase (␥-GTP 396UI/L), amylase (165UI/L), and changes in coagulation markers (prothrombin time 67.7%, D-Dimer 28.7 g/mL, total-fibrinogen degradation product 28.6 g/mL). We could rule out disseminated intravascu-