Anesthetic Management of Atypical Toxic Epidermal Necrolysis in a Six-Month-Old Patient Undergoing Burn Surgery: A Case Report

Abstract

Toxic epidermal necrolysis (TEN) is a rare, life-threatening skin condition that involves widespread skin detachment and mucous membrane damage. We present a case of a six-month-old male with atypical TEN transferred from an outside hospital in Mexico to our facility. The patient had widespread full-thickness necrotic wounds but no bullae or sloughing. Since the diagnosis was unclear at the time, it posed a significant challenge to make an appropriate anesthetic plan given the need for prolonged intubation after extensive burn debridement and grafting surgery. This case report highlights the importance of perioperative assessment, induction strategy, airway management, resuscitation, and pain control in an atypical TEN patient.

Keywords: burn resuscitation; fiberoptic intubation; ketamine and dexmedetomidine; pediatric burn pain management; toxic epidermal necrolysis (ten).

Figure 1. Images of the patient's full-thickness necrotic wounds

The authors discussed and obtained consent from the parent(s) to use the patient's images/information for the purpose of education and research.

Figure 2. Fiberoptic examination of the patient's nasopharynx

Fiberoptic examination demonstrating (A) normal right nasal septum with spotty erythema and (B) mild glottic swelling. Notably, no friability or mucosal bleeding was observed.