She was also given cefotaxime and vancomycin. Now you might say, "but you said not to give antibiotics", but in some instances I think you are forced to. I think the choice of antibiotics should be culture driven. I haven't seen any cases in which either SJS or TEN has been attributable to vancomycin, however there have been some cases where a cephalosporin was the presumed agent. Wound care consisted of Xeroform gauze, as described above.
She had a number of complications during her illness. On day 30 (day 12 of hospitalization), she developed a ventilator-associated pneumonia with Pseudomonas which was treated with meropenem. She then developed a Candida UTI from the Foley which was treated with diflucan. She was eventually extubated and transferred to inpatient rehabilitation by day 37 of her illness. Quite a sustained course!
My aggregate experience with SJS/TEN over the last 10-11 years is shown below.
- 20 patients, 16 females - average age 9 years
- average length of stay 18 days
- 65% body surface area involved
- 95% survival, 1 death from ARDS/ECMO
- 1 pt with visual loss, several with frequent hypopigmentation
The average length of stay of 18 days corresponds to both the presentation of illness and the time for reepithelialization. It can take 2-3 weeks for the skin to slough and reepithelialize. The worst areas are the mucus membranes of the mouth. Interestingly, the plantar surfaces of the feet and the palmar surfaces of the hands will remain blistered and dry and this causes a lot of discomfort for these patients.