D1.303 - Preschooler with Toxic Epidermal Necrolysis Associated with Adenovirus Respiratory Infection
Case report
Introduction: Toxic Epidermal Necrolysis (TEN) is a type IVc cellular hypersensitivity reaction. The primary etiological agents are drugs, followed by infections.
Case Presentation: A previously healthy preschool male, with no recent immunizations or medication use, presented with a one-week history of intermittent fever, green ocular discharge, rhinorrhea, and dry cough. Forty-eight hours after symptom onset, an erythematous papular rash appeared predominantly on the face and then generalized. Initial treatment included clarithromycin and ampicillin for suspected scarlet fever. The dermatosis progressed to a blistering rash with desquamation. Suspecting Kawasaki disease, the patient was transferred to a tertiary care hospital where TEN was diagnosed based on 68% skin involvement and a positive Nikolsky sign.
Treatment included intravenous immunoglobulin, cyclosporine, and biological dressings with mesenchymal cell exosome therapy. The SCORTEN score was 1. The patient did not require advanced airway management, showed no transaminase elevation or renal function impairment, and developed bilateral cicatricial conjunctivitis and a right corneal ulcer as complications. Respiratory secretions identified adenovirus as the sole pathogen.
Studies:
Respiratory PCR Panel: Positive for adenovirus; negative for bocavirus, coronaviruses, rhinovirus/enterovirus, influenza, metapneumovirus, parainfluenza, respiratory syncytial virus (RSV), Mycoplasma pneumoniae, Chlamydia pneumoniae, Legionella pneumoniae, and SARS-CoV-2.
Viral Loads: Negative for Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpesviruses (HHV) 6, 7, and Kaposi's sarcoma virus (KSV).
Cultures: Negative for blood and stool.
Serologies: Positive for CMV IgG, herpes simplex virus (HSV) I and II IgG, and EBV antigen. Negative IgM for all.
Discussion: No drug exposure could be implicated, as symptoms began before medication use. To date, only four publications suggest an association between TEN/Stevens-Johnson Syndrome (SJS) and adenovirus.
Conclusion: Early diagnosis of TEN in previously healthy patients remains challenging due to non-specific initial symptoms and numerous differential diagnoses.
