Toxic Epidermal Necrolysis Complicated By Novel SFTS Bunyavirus Infection: A Case Report And Literature Review

Background: Toxic epidermal necrolysis (TEN) is an extreme,rapidly-evolving skin disease, which is characterized by extensive painful cutaneousexfoliation，this dermatological condition can be life-threatening. In the majority ofthe cases a drug reaction is the cause of TEN. Most commonly involved areantibiotics (such as sulfonamide, tetracycline, quinolones)，anticonvulsants (such asphenytoin, carbamazepine)，nonsteroidal anti-inflammatory drugs or alluporinol. Fewdue to virus infection, cancer, radiation therapy and anti-receptor graft reaction.Clinical manifestation is rapidly spread to the whole body scarlet, dark red andslightly iron gray spots, accompanied by blisters, skin laxity, mucosal damage. Thelesions can become extremely extensive until a complete loss of epidermis. In severecases, the patients can die from infection, electrolyte imbalance and multi-organcomplications. New Buniavirus was first discovered and reported in2010by theChina CDC, which currently named severe fever with thrombocytopenia syndromebunyavirus (SFTS bunyavirus). The clinical manifestations of SFTS bunyavirusinfection are fever, gastrointestinal symptoms, leukopenia, thrombocytopenia, skinbruising, multiple organ failure and other complications. The main cause of death aresevere multiple organ failure.Case presentation: A34-year-old female patient admitted to hospital, becauseof "Fever one week, the whole body rash three days". One week before admitted tohospital the patient presented with fever, lower abdominal discomfort and malaise. She was given paracetamol, levofloxacin, cefminox, metoclopramide and other drugs,but the body temperature kept rising. Three days before admitted to hospital the wholebody of the patient appeared dark patches, skin tenderness and gradually accelerated.More than10days before the onset she went to the countryside, but she denied thehistory of tick bite. No special family history. Physical examination: general conditionshowed slightly stained yellow skin and sclera, limited mouth opening and tonguesticking out. Specialist examination: facial flushing swelling, lips and eyelids mucosalerosion. Whole body showed diffuse dark spots, epidermolysis, Nigeria’s sign (+).Neck and submandibular had several pieces of egg-large flaccid blisters, bullous, theblister fluid being clear. Limb swelled significantly. There are varying degrees oftoenail and fingernail off. Laboratory examination: Examination of blood: WBC3.56×10e9/L、PLT108×10e9/L。ALT2028U/L、AST714U/L、TBIL172.5umol/L、FPG11.2mmol/L、K+3.1mmol/L、Na+123mmol/L. Examination of stool: RBC5-8/HP,WBC full-field/HP, PC into a group distribution/HP, occult blood (+).The heart ratewas120beats per minute, frequent ventricular premature,9-10/min. CT examinationof the chest and abdomen showed no obvious abnormalities. Blood specimens weresent to the China CDC to test viral nucleic acid, the results of serum showed newBunia virus-specific nucleic acid testing positive. Histopathology: the upperepidermal necrosis, the epidermis and dermis separated, there were blisters under theskin. Diagnosis:1.Toxic epidermal necrolysis;2.New SFTS Bunia virus infection;3.Arrhythmia. Treatment: the patient was given a sufficient amount of hormone, IVIGinfusion, fresh plasma, albumin infusion，antidiarrheal and agents to protect the liver,Pay attention to correct the water and electrolyte imbalance, and to care the mouthand eyes. When the disease got controled, hormone reduced gradually. Follow-up ofthe patient showed that the lesions gradually subsided, and no discomfort. Toenailsand fingernails grow again.Conclusion: We report the first case of TEN concurrent with novel SFTSbunyavirus infection. In TEN patients, especially patients with high fever, bloodabnormalitiesand and other organ damage, attention should be paid to rare causessuch as virus infection. Further research on the relationship between TEN and virus infection would contribute to the study of the etiology of TEN, its prevention andtreatment.