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.