Toxic epidermal necrolysis triggered by COVID-19

ABSTRACT

Introduction: Even though the recent outbreak of a novel coronavirus does not severely affect the pediatric population, a previously healthy 15-year-old female, who had started with bilateral conjunctivitis, progressed to toxic epidermal necrolysis (TEN) and multisystem inflammatory syndrome (MIS) in 12 hours. The RT-PCR for SARS-CoV-2 infection was positive with an epidemiologic link 72 hours before onset of symptoms. Methods: The patient was referred to Gutierrez Children’s Hospital intensive care unit (ICU), where she was diagnosed with TEN, bibasal pneumonia and MIS, gammaglobulin and corticosteroids therapy was indicated. She had severe ocular compromise, with bilateral bullous lesions on eyelids and extensive corneal ulcer. We performed amniotic membrane transplantation and placed a symblepharon ring in order to minimize the destructive inflammation and damage of the ocular surface during acute phase. Results: Patient evolution was favorable. She was transferred to the COVID-19 unit after 10 days. Complete reabsorption of amniotic membrane was confirmed in 15 days, symblepharon ring was removed and continued with preservative-free lubricant, cyclosporine 0.05% and serum tears drops. After 35 days of hospitalization, she was discharged with regulated multidisciplinary controls. The patient achieved best-corrected visual acuity 20/20 in both eyes, with moderate dry eye symptoms and localized trichiasis. Conclusion/Relevance In this case, a strong correlation of COVID-19 with TEN was suspected. TEN is a potentially devastating disease that involves permanent painful visual problems. We emphasize early and intensive treatment because the management of the sequelae is extremely challenging, many of the chronic problems are impossible to repair completely.