THERAPEUTIC PLASMA EXCHANGE IN PATIENTS WITH SEVERE CUTANEOUS ADVERSE REACTIONS: A POTENTIAL ADJUNCTIVE THERAPY? REPORT OF TWO CLINICAL CASES
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Abstract
Background: Severe cutaneous adverse reactions , such as Toxic Epidermal Necrolysis and Drug Reaction with Eosinophilia and Systemic Symptoms syndrome, are associated with high mortality rates. Therapeutic Plasma Exchange is considered an adjunctive therapy aimed at removing cytokines and immune complexes.
Objective: To report two clinical cases of Severe Cutaneous Adverse Reactions successfully treated with TPE.
Patients and Method: Case 1: A 60-year-old female diagnosed with Allopurinol-induced Reaction with Eosinophilia and Systemic Symptoms (RegiSCAR score of 6) with hepatic and renal involvement. Case 2: A 51-year-old female diagnosed with Carbamazepine-induced Toxic Epidermal Necrolysis (SCORTEN of 4) involving > 30% body surface area detachment. Both patients received Therapeutic Plasma Exchange using 5% Albumin as the replacement fluid after failing to respond to high-dose intravenous corticosteroids.
Results: Following a series of therapeutic plasma exchange sessions, skin lesions stabilized, liver and renal functions recovered, and both patients remained clinically stable and were transferred out of the intensive care unit after 13 and 16 days, respectively.
Conclusion: Therapeutic Plasma Exchange is a safe and effective adjunctive therapy for Severe Cutaneous Adverse Reactions cases that are refractory to corticosteroid treatment.
Keywords
Therapeutic Plasma Exchange (TPE), Severe Cutaneous Adverse Reactions (SCARs), Toxic Epidermal Necrolysis (TEN), Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
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References
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