Extracorporeal Membrane Oxygenation Therapy in Toxic Epidermal Necrolysis-Related Respiratory Failure: A Case Report

Toxic epidermal necrolysis (TEN) is a rare and life-threatening cutaneous adverse reaction characterized by > 30% total body surface area desquamation and mucosal involvement. Although ocular, oral, and urogenital mucosal involvements are well described, pulmonary mucosal injury is uncommon and associated with high mortality. We report a case of a 33-year-old woman with rapidly progressive TEN complicated by respiratory failure. Despite early multidisciplinary management including local wound care, immunomodulatory therapy, systemic corticosteroids, and lung-protective mechanical ventilation, she developed worsening hypoxemia and hypercarbia with radiographic findings consistent with acute respiratory distress syndrome. As respiratory failure progressed despite maximal conventional therapy, she was cannulated for venovenous extracorporeal membrane oxygenation (ECMO). Following ECMO therapy, her pulmonary infiltrates gradually resolved in parallel with cutaneous re-epithelialization. She underwent tracheostomy for prolonged ventilatory support, was successfully decannulated after 9 days of ECMO support, and survived to discharge. This case adds to the limited data supporting the feasibility of ECMO as a rescue therapy for TEN-associated severe respiratory failure. In carefully selected patients with TEN having refractory respiratory failure, ECMO may serve as an effective bridge to pulmonary recovery. Further studies are needed to better define patient selection, timing, and outcomes in this population.