PMC10435079_01
(A) The patient's severely detached epidermal site was covered with dressings, and diffuse erythematous patches with erosions, ruptured loose bulla, and multisite positive Nikolsky's sign were observed. (B) SCORTEN is assessed based on seven independent parameters within the first 24 hours of admission, with a total score of 5 indicating an estimated mortality rate of 90%.
fimmu-14-1188523-g001.jpg
PMC10435079_01_fimmu-14-1188523-g001.jpg
f1
A male patient in his 60s was admitted to our hospital after experiencing widespread erythema with blister formation, skin pain, and mucosal detachment for 5 days ( Figure 1A  ) and showed no improvement after receiving methylprednisolone (4 mg/kg/d) and intravenous immunoglobulin (IVIG) (0.4 g/kg/d) treatment for 3 days. The Severity-of-Illness Score for TEN (SCORTEN) of 5 was calculated based on objective parameters recorded by dermatologists experienced in managing TEN upon admission ( Figure 1B  ). The total area of detachment (including Nikolsky's sign-positive areas) accounted for 67%.
PMC10435079_02
The timeline of medication history and treatments.
fimmu-14-1188523-g002.jpg
PMC10435079_02_fimmu-14-1188523-g002.jpg
f2
Adalimumab (80 mg, once), IVIG (0.4 g/kg/d, once daily for 5 consecutive days), methylprednisolone (2.5 mg/kg/d, tapered to 1.25 mg/kg/d after improvement, twice daily), and Imipenem/Cilastatin Sodium (0.5 g, three times daily), as well as air-fluidized bed therapy and topical therapy with Kangfuxin, erythromycin ointment, recombinant human basic fibroblast growth factor, and other symptomatic treatments ( Figure 2 ).