Toxic epidermal necrolysis treated with high-dose intravenous immunoglobulin in a patient with liver cirrhosis

Toxic epidermal necrolysis (TEN) is a very dramatic, life-threatening mucocutaneous drug reaction. TEN is characterized by extensive detachment of the epidermis. A 53-year-old man with advanced liver cirrhosis had been treated with lamotrigine (Lamictal) for a convulsive disorder for 7 months before being admitted to hospital with diffuse erythematous maculopapular lesions with extensive confluence that developed on the neck, chest, back, upper arms and thighs and bled spontaneously. The skin lesions worsened rapidly during the initial period of admission despite systemic steroid treatment. Therefore, we tried treating the TEN with high-dose intravenous immunoglobulin (IVIG; 0.5 g/kg/day for 4 consecutive days). The progression of the epidermal detachment stopped within 3 days of starting the IVIG treatment and re-epithelialization was completed in 5 weeks without significant side effects of IVIG. Here, we report a case of life-threatening TEN treated with high-dose IVIG in a patient with advanced liver cirrhosis.