Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
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Case Report

Volume 13, Number 2, February 2022, pages 89-93

Toxic Epidermal Necrolysis-Like Lupus Erythematous Presentation Following SARS-CoV-2 Infection

Figures

Figure 1.
Figure 1. Toxic epidermal necrolysis (TEN)-like lesions in subacute cutaneous lupus (SCL). Large sheets of detached epidermis along the patient’s dorsum (a) and left shoulder (b).
Figure 2.
Figure 2. Skin biopsy showing vacuolar degeneration of the basal layer with scattered apoptotic keratinocytes and a dermal mononuclear cell infiltrate.

Tables

Table 1. Calculation of ALDEN Score [4] for Each Drug Recently or Chronically Administrated
 
DrugALDEN score
Causal linkTotal ALDEN scoreType of drugDechallengePrechallenge/rechallengeDrug present in the body on index dayDelay from initial drug component intake to onset of reaction
ParacetamolVery unlikely-2Associated: 2
Drug with definite but lower risk		Negative: -2
Drug continued without harm		Negative: -2
Exposure without reaction		Excluded: -3
Drug stopped		Suggestive: +3
From 5 to 28 days
Sodium enoxaparinVery unlikely-5Not suspected: -1
No evidence of association		Negative: -2
Drug continued without harm		Negative: -2
Exposure without reaction		Excluded: -3
Drug stopped		Suggestive: +3
From 5 to 28 days
Ipratropium bromideVery unlikely-3Not suspected: -1
No evidence of association		Neutral: 0
Drug stopped or unknown		Negative: -2
Exposure without reaction		Excluded: -3 Drug stoppedSuggestive: +3
From 5 to 28 days
DexamethasoneVery unlikely-1Not suspected: -1
No evidence of association		Neutral: 0
Drug stopped or unknown		Not done/unknown: 0
No known previous exposure		Excluded: -3 Drug stoppedSuggestive: +3
From 5 to 28 days
TelmisartanVery unlikely-3Unknown: 0Neutral: 0
Drug stopped (or unknown)		Negative: -2
Exposure without reaction		Definite: 0
Drug continued		Unlikely: -1
> 56 days

 

Table 2. Full Blood Workup Alterations
 
Result (normal range)
IgG: immunoglobulin G; IgM: immunoglobulin M; EBNA: Epstein-Barr nuclear antigen; HBsAg: hepatitis B surface antigen; HBsAb: hepatitis B surface antibody; HBcAb: hepatitis B core antibody; Ag: antigen; Ab: antibody.
Blood test
  Leucocytes14.3 × 109/L (3.6 - 10.5 × 109/L)
  Neutrophils9.3 × 109/L (1.5 - 7.7 × 109/L)
  Hemoglobin9.9 g/dL (12 - 16 g/dL)
  Mean corpuscular volume84 fL (80 - 100 fL)
  Erythrocyte sedimentation rate51 mm/h (1 - 20 mm/h)
  C-reactive protein20.1 mg/dL (0.5 - 1 mg/dL)
  Procalcitonin0.67 ng/mL (0 - 0.5 ng/mL)
  Lactate dehydrogenase585 U/L (< 247 U/L)
  Ferritin2,790 ng/mL (30 - 300 ng/mL)
  Albumin1.6 g/dL (3.5 - 5.2 g/dL)
Immune and autoimmune tests
  Complement component 30.66 g/L (0.83 - 1.93 g/L)
  Complement component 40.1 (0.15 - 0.57)
  Antinuclear antibodiesPositive (1:1,280, nuclear homogeneous pattern)
  Extractable nuclear antigens antibodiesSSA60 (Ro60)/SSB (La) positive
Urine analysis
  24 h proteinuria642 mg/24 h (50 - 80 mg/24 h)
Blood serologies
  CytomegalovirusNegative (IgM and IgG)
  Herpes simplex virus 1 and 2Negative (IgM and IgG)
  Epstein-Barr virusNegative (IgM, IgG and EBNA)
  Hepatitis B virusNegative (HBsAg, HBsAb and HBcAb)
  Hepatitis C virusNegative (IgM and IgG)
  Hepatitis A virusNegative (IgM and IgG)
  Human immunodeficiency virusNegative (Ag/Ab)
  Treponema pallidumNegative (IgM and IgG)
  Rickettsia conoriiNegative (IgM and IgG)
  Coxiella burnetiiNegative (IgM and IgG)