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November 1992

Toxic Epidermal Necrolysis After Hepatic Transplantation

Author Affiliations

Department of Dermatology; Academic Department of Medicine; Academic Department of Surgery The Royal Free Hospital and School of Medicine Pond Street Hampstead London, England NW3 2QG

Arch Dermatol. 1992;128(11):1550-1551. doi:10.1001/archderm.1992.01680210130027

To the Editor.—  We describe a patient in whom a clinical syndrome indistinguishable from toxic epidermal necrolysis (TEN) developed after a liver transplant.

Report of a Case.—  A 44-year-old Pakistani woman had a liver transplant in December 1990 for anti-hepatitis C virus-positive cirrhosis. A complicated postoperative period followed resulting in 8 weeks in intensive care.A liver biopsy specimen on day 8 showed severe acute cellular rejection, and this was treated with 5 mg/d of OKT3 murine monoclonal antibody (Cilag, United Kingdom) for 5 days. Thrombocytopenia, which was found to be IgG and IgM mediated, was successfully treated with pooled normal human immunoglobulin (Bayer, United Kingdom). Postoperatively, a pyrexia up to 42°C developed and this persisted for 8 weeks. No organism was identified and the pyrexia was thought to be due to a possible combination of sepsis and rejection. Empirical treatment with antibiotics (clindamycin, vancomycin, ciprofloxacin, and ceftazidime), antifungals (fluconazole and amphotericin),

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