Stevens–Johnson Sendromu/Toksik Epidermal Nekroliz: Yoğun Bakım Yönetimi ve İmmünmodülatör Tedaviler
Özet
Stevens-Johnson sendromu (SJS) ve toksik epidermal nekroliz (TEN), nadir ancak yüksek mortalite riski taşıyan ilaç veya enfeksiyon kaynaklı ciddi mukokutanöz aşırı duyarlılık reaksiyonlarıdır. Patogenezde sitotoksik T lenfosit aracılı keratinosit apoptozu temel rol oynamaktadır. Tanı klinik bulgulara dayanır ve prognoz SCORTEN skoru ile öngörülebilir. Yönetimde nedensel ilacın kesilmesi, yoğun bakim desteği, sivi-elektrolit replasmanı, enfeksiyon kontrolü ve yara bakimi esastır. Farmakolojik tedaviler arasında kortikosteroidler, intravenöz immünoglobulin, siklosporin ve TNF-a inhibitörleri yer almakta, özellikle siklosporin ve kortikosteroid-IVIG kombinasyonu umut verici sonuçlar vermektedir. Bu bölümde sunulan olguda, allopurinol kullanımı sonrası hızla gelişen SJS/TEN tablosu multidisipliner yoğun bakim desteği, kortikosteroid ve IVIG tedavisi ile kontrol altına alinmiş ve klinik iyileşme sağlanmıştır. Olgu, erken tanı ve yoğun bakim desteğinin mortaliteyi azaltmadaki kritik rolünü vurgulamaktadır.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but serious mucocutaneous hypersensitivity reactions caused by drugs or infections with a high mortality risk.
Cytotoxic T lymphocyte-mediated keratinocyte apoptosis plays a major role in the pathogenesis. Diagnosis is based on clinical findings, and prognosis can be predicted by the SCORTEN score.
Management is based on discontinuation of the causative drug, intensive care support, fluid-electrolyte replacement, infection control, and wound care. Pharmacologic therapies include corticosteroids, intravenous immunoglobulin, cyclosporine, and TNF-α inhibitors, and especially the combination of cyclosporine and corticosteroids-IVIG has shown promising results. In the case presented in this chapter, the rapidly developing SJS/TEN after allopurinol use was controlled with multidisciplinary intensive care support, corticosteroid, and IVIG therapy, and clinical improvement was achieved. The case highlights the critical role of early diagnosis and intensive care support in reducing mortality.
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