Nutritional intervention in a patient with severe toxic epidermal necrolysis: A case report

Tóm tắt

A 70-year-old male with hypertension, gout, and stage 3a chronic kidney disease was admitted with fever, cough, and poor appetite. On day 2, he developed widespread bullae and mucosal erosions involving 70% of body surface area (BSA), leading to a diagnosis of severe toxic epidermal necrolysis (TEN). Multidisciplinary management in the intensive care unit included wound care, respiratory support, infection control, and early individualized nutritional therapy. Enteral feeding was initiated on ICU day 4, advancing to 1800 kcal/day (~30 kcal/kg/day) and 1.7 g/kg/day protein, including arginine, glutamine, vitamins C and E, and zinc, while monitoring renal and fluid-electrolyte status. Nitrogen balance was considered non-negative based on Nutrition Focused Physical Exam by the same experienced clinician, supported by stable weight from admission to discharge and rising serum albumin. Inflammatory markers decreased, lesions healed, and oral intake resumed. The patient was discharged in stable condition. This case highlights the feasibility and safety of early high-protein immunonutrition in TEN with chronic kidney disease, underscoring the importance of tailored nutrition as a core component of critical dermatologic care.