Shock Syndromes II
| (h) | The decision to administer IVIG remains clinically supported by pathophysiology- |
|---|
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?