develop disseminated intravenous co

develop disseminated intravenous coagulation (DIC). Within the 3
cases, 2 cases died (described in deceased cases) and only 1 case
was survived. Alived case was 72-year-old man and he also had
hepatitis and severe renal dysfunction needed to receive hemodialysis.
A case of sepsis in SJS was 87-year-old woman who already
had pneumonia when she developed SJS and the treatment was
started 9 days after the development of SJS.
Treatments
The major systemic treatments that were adopted in addition to
supportive care were corticosteroids, IVIG, and plasmapheresis. The
treatments performed are shown in Table 3. All cases, except 2
cases of SJS and 1 case of TEN, were treated with corticosteroids
with or without other therapies. Prompt tapering of the steroid
dose was performed along with amelioration of symptoms. In SJS,
most cases (45 cases, 86.5%) were treated with corticosteroids
alone. Of the cases, 18 (34.6% of all SJS) were performed pulse
therapy (500e1000 mg/day of methylprednisolone for 3 days). On
the other hand, in TEN, steroid pulse therapy was performed in 31
cases (88.6%) of all cases. Less than half cases (14 cases, 40%) were
treated with corticosteroids alone and among them 12 cases were
performed pulse therapy (500e1000 mg/day of methylprednisolone
for 3 days). The case treated without steroid was a 62-year-old
woman who was treated with IVIG (20 g/day for 2 days) alone,
because she had acquired Methicillin-resistance Staphylococcus
aureus (MRSA) pneumonia after the operation of acute aorta
dissection when she developed TEN. IVIG was highly effective in
this case and resulted in remarkable recovery from the TEN
eruption.
A combination treatment with IVIG and corticosteroids was
performed only in 3 cases of SJS. All 3 cases received less than 2 g/kg
(more than 1 g/kg) of immunoglobulin in total. Two of the 3 cases
were performed pulse therapy (500e1000 mg/day of methylprednisolone
for 3 days). One case of SJS was already being treated with
60 mg/day of prednisolone for systemic lupus erythematosus when
she developed SJS and she received the additional treatment of
double filtration plasmapheresis (DFPP). Another SJS case was
treated with corticosteroids, IVIG, and plasmapheresis sequentially.
This case had developed SJS as a reaction to diaphenylsulfone (DDS)
taken for pemphigus foliaceus. To treat pemphigus foliaceus
together with SJS, DFPP was performed.
On the other hand, combination therapies were positively chosen
in TEN. Before starting IVIG or plasmapheresis, all cases were
performed steroid pulse therapy. Eight cases (22.9%) were treated
with the combination of IVIG (more than 1 g/kg) and corticosteroids,
and 10 cases (28.6%) with the combination of plasmapheresis
and corticosteroids. Two cases (5.7%) were treated with steroid
pulse, IVIG, and plasmapheresis because of the progression of
symptoms. In contrast to SJS, 2 cases of TEN treated with IVIG after
2008 were administered with a total amount of more than 2 g/kg
immunoglobulin. All plasmapheresis treatments performed in TEN
were plasma exchange (PE) except for 1 case treated with steroid
pulse, IVIG (1 g/kg), and DFPP before 2006.
Mortality, deceased cases, and sequelae
Total mortality was 6.9%. One case of SJS (mortality rate, 1.9%)
and 5 cases of TEN (mortality rate, 14.3%) died. The average
SCORTEN score was 2.34, thus the predicted mortality rate was
25.3% (8.9 cases) in TEN.
A summary of the deceased cases is shown in Table 4. The
deceased SJS case was a 47-year-old man. He developed an acute
respiratory disorder after the eruption had begun to show signs of
recovery. The death was doubted to have been caused by the malignant
lymphoma that was the primary disease. As for TEN, the
ages of the deceased cases varied from 39 to 79 years, with an
average age of 63.4 years. All cases were treated with corticosteroids
and 3 of them were treated with combination therapy of IVIG
(

Results (Indonesian) 1:

mengembangkan menyebarkan intravena koagulasi (DIC). Dalam 3kasus, kasus 2 mati (dijelaskan dalam kasus almarhum) dan hanya 1 kasusSelamat. Kasus Alived adalah laki-laki berusia 72 tahun dan dia juga mempunyaiHepatitis dan disfungsi ginjal berat yang diperlukan untuk menerima hemodialisis.Kasus sepsis di SJS adalah 87-tahun-wanita tua yang sudahradang paru-paru ketika ia dikembangkan SJS dan pengobatan adalahmulai 9 hari setelah pembangunan SJS.PerawatanPengobatan sistemik utama yang diadopsi Selainperawatan suportif adalah kortikosteroid, IVIG, dan Plasmaperesis. Theperawatan dilakukan ditunjukkan dalam tabel 3. Semua kasus, kecuali 2kasus SJS dan 1 kasus sepuluh, yang diperlakukan dengan kortikosteroiddengan atau tanpa terapi lain. Meminta meruncing steroiddosis ini dilakukan bersama dengan triptofan gejala. Di SJS,kebanyakan kasus (45 kasus, 86.5%) diperlakukan dengan kortikosteroidsendirian. Kasus, 18 (34.6% dari semua SJS) dilakukan pulsaterapi (500e1000 mg/hari dari methylprednisolone selama 3 hari). Padasisi lain, dalam sepuluh, terapi steroid pulsa dilakukan dalam 31kasus (88.6%) dari semua kasus. Kurang dari setengah kasus (14 kasus, 40%)diobati dengan kortikosteroid sendirian dan di antara mereka kasus 12Terapi dilakukan pulsa (500e1000 mg/hari methylprednisoloneselama 3 hari). Kasus yang diobati tanpa steroid adalah 62 tahunwanita yang diobati dengan IVIG (20 g/hari selama hari 2) sendirian,karena dia telah diperoleh tahan Methicillin Staphylococcusaureus (MRSA) pneumonia after the operation of acute aortadissection when she developed TEN. IVIG was highly effective inthis case and resulted in remarkable recovery from the TENeruption.A combination treatment with IVIG and corticosteroids wasperformed only in 3 cases of SJS. All 3 cases received less than 2 g/kg(more than 1 g/kg) of immunoglobulin in total. Two of the 3 caseswere performed pulse therapy (500e1000 mg/day of methylprednisolonefor 3 days). One case of SJS was already being treated with60 mg/day of prednisolone for systemic lupus erythematosus whenshe developed SJS and she received the additional treatment ofdouble filtration plasmapheresis (DFPP). Another SJS case wastreated with corticosteroids, IVIG, and plasmapheresis sequentially.This case had developed SJS as a reaction to diaphenylsulfone (DDS)taken for pemphigus foliaceus. To treat pemphigus foliaceustogether with SJS, DFPP was performed.On the other hand, combination therapies were positively chosenin TEN. Before starting IVIG or plasmapheresis, all cases wereperformed steroid pulse therapy. Eight cases (22.9%) were treatedwith the combination of IVIG (more than 1 g/kg) and corticosteroids,and 10 cases (28.6%) with the combination of plasmapheresisand corticosteroids. Two cases (5.7%) were treated with steroidpulse, IVIG, and plasmapheresis because of the progression ofsymptoms. In contrast to SJS, 2 cases of TEN treated with IVIG after2008 were administered with a total amount of more than 2 g/kgimmunoglobulin. All plasmapheresis treatments performed in TENwere plasma exchange (PE) except for 1 case treated with steroidpulse, IVIG (1 g/kg), and DFPP before 2006.Mortality, deceased cases, and sequelaeTotal mortality was 6.9%. One case of SJS (mortality rate, 1.9%)and 5 cases of TEN (mortality rate, 14.3%) died. The averageSCORTEN score was 2.34, thus the predicted mortality rate was25.3% (8.9 cases) in TEN.A summary of the deceased cases is shown in Table 4. Thedeceased SJS case was a 47-year-old man. He developed an acuterespiratory disorder after the eruption had begun to show signs ofrecovery. The death was doubted to have been caused by the malignantlymphoma that was the primary disease. As for TEN, theages of the deceased cases varied from 39 to 79 years, with anaverage age of 63.4 years. All cases were treated with corticosteroidsand 3 of them were treated with combination therapy of IVIG(<2 g/kg) or PE. Sepsis and DIC accompanied TEN in 3 cases. A 79-year-old woman caused sepsis and DIC after developing severerenal dysfunction. In this case, the dose of the administered corticosteroidswasincreased gradually fromprednisolone 30 mg/day to100 mg/day and finally changed to betamethasone 20 mg/day. A54-year-old man case already had showed very severe generalcondition at the start of the treatment of TEN, which made itdifficult to administer the corticosteroids at the high-dose, andended to septic shock. A 71-year-old woman had developed TENduring the treatment of fever of unknown origin, which could besuspicious of some kind of systemic infection hidden and led toseptic shock and DIC.No cases showed severe sequelae in either SJS or TEN. Only 1case of TEN, a 17-year-old man, showed a loss of fingernails.Although many reports indicate that eye complications often resultin severe eye sequelae, no cases in this study showed eye sequelae