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[ABCD-10 scale as a predict of mortality in children with severe pharmacodermias. Case report]
Britza Barrios-Díaz1, Ana Paola Macías-Robles2, Héctor Hugo Campos-Téllez2
1Servicio de Alergia e Inmunología Clínica Pediátrica, Hospital de Pediatría, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México. bribadi@hotmail.com.
Insights
Severe pharmacodermias (SF) carry high mortality risks, especially in children with chronic kidney failure (CKD) on dialysis. The ABCD-10 scale may better predict mortality in these cases than SCORTEN.
Area of Science:
- Pharmacology
- Nephrology
- Pediatrics
Background:
- Severe pharmacodermias (SF) are linked to significant morbidity and mortality.
- Chronic kidney failure (CKD) requiring dialysis is a key factor in increased mortality risk.
- The ABCD-10 scale, incorporating dialysis history, is a predictive mortality tool.
Observation:
- A 2-year-old male with CKD on peritoneal dialysis and Lennox-Gastaut syndrome developed Stevens-Johnson syndrome-toxic epidermal necrolysis (SJS-NET) after phenytoin administration.
- The patient experienced acute peritonitis and septic shock, with treatment including immunoglobulin and systemic steroids proving ineffective.
- The case resulted in a fatal outcome.
Findings:
- The ABCD-10 scale demonstrated a higher mortality prediction compared to SCORTEN in this case, attributed to the patient's dialysis history.
- Currently, no validated pediatric mortality prediction scales exist for severe pharmacodermias.
- Dialysis history appears to be a critical factor in mortality prediction for pediatric SF.
Implications:
- This case highlights the limitations of existing scales like SCORTEN in pediatric severe pharmacodermias.
- There is a critical need to develop specific, validated mortality prediction scales for children experiencing severe pharmacodermias.
- Further research should focus on identifying unique risk factors for mortality in pediatric SF patients to inform scale development.
Background:
The severe pharmacodermias (SF) are associated with high morbidity and mortality. Chronic kidney failure (CKD) related with dialysis is one of the main factors associated with higher mortality. ABCD-10 is a predictive mortality scale that includes the history of dialysis.
Case Report:
Male 2 years old with a history of CKD on peritoneal dialysis and Lennox-Gastaut syndrome, admitted to the hospital due to acute peritonitis and developed SJS-NET secondary to phenytoin administration. He was treated with immunoglobulin and systemic steroid without improvement. Septic shock was added, presenting a fatal outcome.
Conclusions:
In the case presented, the ABCD-10 scale was applied, reporting a greater prediction of mortality compared to SCORTEN due to a history of dialysis. In children with SF there are no validated predictive mortality. Future initiatives should search for risk factors for mortality in children who develop SF for the creation of a predictive mortality scale.
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