[Toxic epidermal necrolysis (Lyell's syndrome) after rubella]

Rubella was confirmed clinically and serologically in a 14-year-old boy who had been admitted with mild general symptoms and an exanthematous rash presenting with medium size maculae. Within only three days the exanthema had faded. Five days later the boy again became ill with high fever (40 degrees C) and renewed erythema with at first irregular then rosette-like and widely confluent spots. On admission several nonspecific inflammatory signs were markedly elevated (erythrocyte sedimentation rate, C-reactive protein, alpha-globulin). There were mild abnormalities of left-ventricular repolarization at the electrocardiography. The skin changes were progressive and at first interpreted as erythema exudativum multiforme. Fever persisted, despite antibiotic treatment, and signs of epidermolysis appeared. After the diagnosis of non-staphylogenic Lyell's disease was made high-dosage prednisolone administration was begun (initially 3 mg/kg in 6 hours, then 2.5 mg/kg daily for 8 days). The patient's condition and the electrocardiographic findings returned to normal within 2 days. The epidermolysis was arrested within a few hours and the blisters dried out within 24 hours. There were no complications. Since no drugs were given before the second day of epidermolysis being noted, it is highly likely that rubella precipitated Lyell's disease.