Tu-Anh Duong

Acute Respiratory Failure in Patients With Toxic Epidermal Necrolysis: Clinical Features and Factors Associated With Mechanical Ventilation

Objectives:Stevens-Johnson syndrome and toxic epidermal necrolysis are severe adverse cutaneous drug reactions characterized by widespread skin and mucous membrane detachments, including bronchial mucosa, which may be associated with respiratory failure requiring mechanical ventilation. The presentation and outcome of patients requiring mechanical ventilation and the characteristics of bronchial epithelial lesions among ventilated patients are reported. Predictors of mechanical ventilation available on hospital admission were identified using univariate and multivariate logistic regressions. Design:Retrospective cohort study. Setting:Medical ICU and dermatology department of a tertiary care hospital, which hosts the French national referral center for toxic epidermal necrolysis. Patients:Patients admitted for Stevens-Johnson syndrome/toxic epidermal necrolysis over a 14-year period were included. Interventions:None. Measurements and Main Results:Of the 221 patients included in the study, 56 patients (25.3%) required mechanical ventilation. None of the patients received noninvasive ventilation. Patients requiring mechanical ventilation had a larger baseline detached body surface area, higher Logistic Organ Dysfunction score, and Simplified Acute Physiology Score II, and they presented more often with shock, pulmonary infiltrates, and renal dysfunction (p < 0.0001 for all comparisons). Among patients receiving mechanical ventilation, 57% of the patients died; those having bronchial epithelial lesions (22 of 56) required intubation earlier than others (1 [1–4] vs 4 [1–6] d after hospital admission; p = 0.027). Variables associated with mechanical ventilation in multivariate analysis included serum bicarbonates less than 20 mM (odds ratio, 4.9 [95% CI, 1.1–22.7]; p = 0.041), serum urea greater than 10 mM (odds ratio, 7.0 [95% CI, 2.2–22.8]; p < 0.001), a detached body surface area between 10% and 29% (odds ratio, 3.7 [95% CI, 1.0–13.8]; p = 0.048) or greater than or equal to 30% (odds ratio, 19.7 [95% CI, 4.4–87.4]; p < 0.0001), WBCs more than 12,000/mm3 (odds ratio, 11.6 [95% CI, 2.8–48.1]; p < 0.001), blood hemoglobin less than 8 g/dL (odds ratio, 8.1 [95% CI, 1.2–55.2]; p = 0.032), and more extensive pulmonary infiltrates (odds ratio, 9.7 [95% CI, 3.6–25.9]; p < 0.0001). Conclusions:Mechanical ventilation is required in one of four Stevens-Johnson syndrome/toxic epidermal necrolysis patients and is associated with a poor outcome. Prompt identification of Stevens-Johnson syndrome/toxic epidermal necrolysis patients at higher risk of intubation could help guide their early management, particularly for those having bronchial epithelial lesions.

Stevens–Johnson syndrome and toxic epidermal necrolysis: follow‐up of pulmonary function after remission

Acute‐stage specific bronchial epithelial detachment has been described in 27% of patients with Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN).

Pulmonary cryptococcoma in a patient with Sézary syndrome treated with alemtuzumab

ejd.2011.1538 Auteur(s) : Claire Hotz1,a q claire.hotz@gmail.com, Saskia Ingen-Housz-Oro1,a, Jeanne Tran Van Nhieu2, Caroline Charlier3, Francoise Foulet4, Alain Rahmouni5, Benhalima Zegai5, Tu-Anh Duong1, Pierre Wolkenstein1, Martine Bagot6,a, Olivier Chosidow1,a 1 Department of Dermatology 2 Department of Pathology, Henri-Mondor hospital, 51 avenue du marechal-de-Lattre-de-Tassigny, 94010 Creteil, France 3 Department of Infectious Diseases, Necker–Enfants Malades Hospital, Paris, France 4 [...]

Epidermal necrolysis and autoimmune diseases: two more observations supporting the concept that ‘toxic’ epidermal necrolysis can be ‘non-toxic’

Toxic epidermal necrolysis (TEN, Lyell syndrome) and Stevens-Johnson syndrome are severe cutaneous adverse reactions to drugs characterized by epidermal necrolysis (EN). However, in 15% of cases, no causative drug is identified. In these cases, other triggers such as Mycoplasma pneumoniae have been described. Furthermore, the role of lupus as triggering factor has been suggested. We report 2 cases of EN without any drug causality, revealing autoimmune diseases as a cause. This article is protected by copyright. All rights reserved.

Severe cutaneous adverse reactions due to inappropriate medication use

The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.

Post-traumatic stress disorder in Stevens-Johnson syndrome and toxic epidermal necrolysis: prevalence and risk factors. A prospective study of 31 patients

Epidermal necrolysis is a rare and severe cutaneous adverse reaction to drugs with long‐term somatic consequences and potentially underrecognized psychological complications.

Analysis of Implementation of Care Coordination in a Multi-level Care Provider Organization: A Need for Systems Approaches

Better care coordination is a crucial objective to answer to the rising complexity of healthcare and the associated increase in costs. Process-based organizations is a widely recommended method for achieving this goal. In this article an initiative of implementing a care process in a French public hospital group is analyzed. The procedure to design the care process is documented and the official care process is compared to the current situation in a hospital. This analysis shows how important local parameters are in such projects. The shortcomings of the approach are identified and propositions to overcome these issues are made.

Emerging Telemedicine Analysis of Future Teledermatology Application in France

World health organization (WHO) defines Telemedicine (TM) as the use of IT technologies to provide clinical healthcare at distance. This past decade, scientific production provided a great number of publications focusing on TM feasibility studies and medical applications.