IVIG and TEN: What Are We to Believe, and How Should We Manage Our Next Patient?

Toxic epidermal necrolysis and Stevens-Johnson syndrome (TEN and SJS), often related to the use of a new therapeutic agent, are acute processes with a high rate of morbidity and with possible mortality. The risk for mortality is linked to the extent of blistering and to the presence of comorbid disease.

In 1998, I was enthusiastic when Viard and colleagues published a 10-patient study suggesting that intravenous immunoglobulin (IVIG) was beneficial for TEN and SJS. Since then, however, multiple case reports and case series have had conflicting results. The presumption is that if IVIG adds benefit, it does so when given in high doses and soon after disease onset; however, debate remains on both the appropriate dose and the optimal timing.

Now,…