Shock Syndromes II

pharmacology interactions and observational data. Centers with expertise to care for

patients with TEN should assess the usefulness of IVIG and develop interdisciplinary

guidance for local use.

vi.

Consensus guidelines from the United Kingdom recommend that immunomodulating therapies

be used under the supervision of skin failure specialists in the context of a clinical study or

registry. In contrast, consensus guidelines from India recommend (grade B recommendation)

that low-dose IVIG be considered in the first 24 to 48 hours in patients with HIV, children, and

pregnant women in the first trimester.

Patient Case

Questions 9 and 10 pertain to the following case.

L.H. is a 23-year-old woman diagnosed with an uncomplicated UTI. Two days after starting sulfamethoxa-

zole-trimethoprim, she presents to the burn ICU from an outside hospital with severe systemic inflammatory

response and 30% TBSA epidermolysis of her upper arms and back. Six hours earlier, she had only 10% TBSA

involvement. During her stay in the burn ICU, new lesions develop on her thighs and oral cavity, increasing

TBSA involvement to 40%, consistent with TEN. L.H.’s SCORTEN score is 3.

Which is the most appropriate initial pharmacotherapeutic intervention for L.H.?

acute kidney injury, you and your team consider IVIG as a pharmacotherapeutic intervention. Which best

reflects the evidence-based role of IVIG in managing TEN?