Discussion
Toxic epidermal necrolysis is a rare skin condition in which the body loses its barrier function and renders individual susceptible to contract infections. A recent systematic review and meta-analysis has shown that, apart from supportive care, several immunodulators such as cyclosporine could have potential mortality benefits for TEN patients4. Recently, protective effect of cyclosporine has been determined in Covid-19 patients due to its potential to downregulate the cytokine storm and toxic T-cells proliferation induced by SARS-CoV-2, to inhibit viral replication and to prevent acute lung injury 5,6.
In addition, the initially negative PCR for Covid-19 in our patient could have been a false negative result. There is a previous report of one symptomatic SJS/TEN case whose PCR turned positive following two negative results 7. The false negative PCR should be considered in patients with respiratory symptoms specially in high-risk ones.
Finally, both bleeding and thrombotic complications are commonly reported following Covid-19 infection mainly due to the disseminated inflammation leading to hypercoagulability causing DVT or PE, and eventually death 8. In managing Covid-19 patients, the physicians should screen for these complications and use anticoagulants when necessary. Although our patient was receiving Rivaroxaban, she developed DVT and pneumatic emboli even after being discharged in a favorable condition. Thus, in managing patients with multiple respiratory comorbidities during Covid-19 era a multidisciplinary approach is to be preconized.