Case of toxic epidermal necrolysis in immunocompromised patient possibly due to Streptococcus pneumoniae serotype uncovered by vaccine
Abstract
Dear Editor, A 56-year-old man underwent a splenectomy for the diagnosis of malignant lymphoma (ML). He immediately received vaccination with PNEUMOVAX 23 (Merck & Co., Inc., Whitehouse Station, NJ, USA) to prevent infection from pneumococcus. He achieved complete response of ML by the chemotherapy. After 4 years, he experienced sudden high fever and visited his nearest outpatient clinic. He was treated with levofloxacin and non-steroidal anti-inflammatory drugs for the diagnosis of bacterial infection. However, his general condition worsened rapidly and he experienced respiratory failure and became unconsciousness, requiring prompt intubation and urgent dialysis. He developed multiple organ failure (MOF) and disseminated intravascular coagulation (DIC) due to septic shock only 2 days after onset. He was transported to our hospital to receive strict whole-body control. He was diagnosed with overwhelming post-splenectomy infection (OPSI) by Streptococcus pneumonia, the antigen of which was detected in his urine and growth positive in his blood. His whole-body skin including mucous area promptly became necrotic with bulla formation in some parts (Fig. 1a,b). A skin biopsy specimen from a hemorrhagic bulla showed suprabasal bulla with keratinocyte necrosis accompanied by eosinophil infiltrates (Fig. 1c), suggesting toxic epidermal necrolysis (TEN). We also measured interleukin (IL)-8 concentration in the serum and bullae at the first consultation, referring to the previous…
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