Toxische epidermale Nekrolyse in der Schwangerschaft – ein Fallbericht

Toxic epidermal necrolysis (TEN) is a extremely rare but potentially lethal skin disease associated most often with commonly used drugs such as antibiotics. We report a pregnant patient with the classical signs and symptoms together with several potential triggers of TEN. After a prodromal stage our patient developed widespread, extremely painful rapidly progressing edematous skin lesions with mucous membrane participation which required admission to an intensive care unit. During the acute life-threatening phase the pregnancy and the prematurity of the fetus presented a particular challenge. The relatively quick stabilization of our patient's condition was unexpected and the originally prognosticated necessity for respiratory support did not occur. Even the continuation of the pregnancy was uncomplicated and a healthy girl was delivered vaginally at 36 weeks' gestation. There is no definite specific treatment for TEN and the guidelines are controversial, although there is general agreement that immediate cessation of the suspected causative drug is essential. The principles of emergency treatment of patients with TEN are similar to those for patients with extensive thermal burns. Clinicians are confronted with a great heterogeneity in the presentation of this disorder and the impossibility of predicting the course of the disease at initial presentation.