{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T15:06:59Z","timestamp":1787497619251,"version":"build-2736575974"},"reference-count":17,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["EBJ"],"abstract":"<jats:p>Introduction: Toxic epidermal necrolysis in children is a life-threatening emergency requiring prompt withdrawal of the culprit drug, transfer to an experienced center, and intensive supportive care. Case Report: An 11-year-old girl developed toxic epidermal necrolysis involving 90 percent of total body surface area after exposure to a nonsteroidal anti-inflammatory drug, with concomitant viral positivity. At the referring pediatric hospital, on day 2 the patient received high-dose intravenous immunoglobulin 2 g\/kg and a single infusion of infliximab 5 mg\/kg. She was transferred on day 6 to our Burn Unit. Histopathology confirmed complete epidermal loss. Treatment included IgM- and IgA-enriched intravenous immunoglobulin over 72 h and methylprednisolone 0.74 mg\/kg\/day for 30 days. Cryopreserved amniotic membrane was applied to trunk and limbs, and fluorescent light energy to the face. Complete re-epithelialization occurred within 14 days without complications. Pain resolved rapidly, with a Visual Analog Scale score of 0 on day 2. At 6 months, skin and mucosae were intact with only transient dyschromia. Conclusions: In this child with extensive toxic epidermal necrolysis and high predicted mortality, IgM\/IgA-enriched immunoglobulin, low-dose corticosteroid and early staged cryopreserved amnion were associated with infection-free, complete re-epithelialization and full functional recovery.<\/jats:p>","DOI":"10.3390\/ebj7030037","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:16:18Z","timestamp":1783527378000},"page":"37","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["IgM- and IgA-Enriched Intravenous Immunoglobulin Combined with Cryopreserved Human Amniotic Membrane for Pediatric Toxic Epidermal Necrolysis: A Case Report"],"prefix":"10.3390","volume":"7","author":[{"given":"Alfio Luca","family":"Costa","sequence":"first","affiliation":[{"name":"Plastic, Reconstructive and Aesthetic Surgery Department, Padua University Hospital, Via Nicol\u00f2 Giustiniani 2, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Bastin","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Aesthetic Surgery Department, Padua University Hospital, Via Nicol\u00f2 Giustiniani 2, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro Jad","family":"Patelli","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Aesthetic Surgery Department, Padua University Hospital, Via Nicol\u00f2 Giustiniani 2, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aurora","family":"Carnio","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Aesthetic Surgery Department, Padua University Hospital, Via Nicol\u00f2 Giustiniani 2, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6638-9010","authenticated-orcid":false,"given":"Vincenzo","family":"Vindigni","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Aesthetic Surgery Department, Padua University Hospital, Via Nicol\u00f2 Giustiniani 2, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Franco","family":"Bassetto","sequence":"additional","affiliation":[{"name":"Plastic, Reconstructive and Aesthetic Surgery Department, Padua University Hospital, Via Nicol\u00f2 Giustiniani 2, 35128 Padua, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1038\/clpt.2009.252","article-title":"ALDEN, an algorithm for assessment of drug causality in Stevens\u2013Johnson Syndrome and toxic epidermal necrolysis: Comparison with case\u2013control analysis","volume":"88","author":"Sassolas","year":"2010","journal-title":"Clin. Pharmacol. Ther."},{"key":"ref_2","first-page":"1019","article-title":"Correlations between clinical patterns and causes of erythema multiforme majus, Stevens-Johnson syndrome, and toxic epidermal necrolysis: Results of an international prospective study","volume":"138","author":"Mockenhaupt","year":"2002","journal-title":"Arch. Dermatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1046\/j.1523-1747.2000.00061.x","article-title":"SCORTEN: A severity-of-illness score for toxic epidermal necrolysis","volume":"115","author":"Fouchard","year":"2000","journal-title":"J. Investig. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1126\/science.282.5388.490","article-title":"Inhibition of toxic epidermal necrolysis by blockade of CD95 with human intravenous immunoglobulin","volume":"282","author":"Viard","year":"1998","journal-title":"Science"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1542\/peds.112.6.1430","article-title":"Use of intravenous immunoglobulin in children with stevens-johnson syndrome and toxic epidermal necrolysis: Seven cases and review of the literature","volume":"112","author":"Metry","year":"2003","journal-title":"Pediatrics"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1186\/s13613-020-00740-1","article-title":"Best-practice IgM- and IgA-enriched immunoglobulin use in patients with sepsis","volume":"10","author":"Nierhaus","year":"2020","journal-title":"Ann. Intensiv. Care"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1186\/s13613-019-0609-5","article-title":"IgM-enriched immunoglobulins (Pentaglobin) may improve the microcirculation in sepsis: A pilot randomized trial","volume":"9","author":"Domizi","year":"2019","journal-title":"Ann. Intensiv. Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"88","DOI":"10.22203\/eCM.v015a07","article-title":"Properties of the amniotic membrane for potential use in tissue engineering","volume":"15","author":"Niknejad","year":"2008","journal-title":"Eur. Cells Mater."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e0135324","DOI":"10.1371\/journal.pone.0135324","article-title":"Amniotic Membrane Modifies the Genetic Program Induced by TGF\u00df, Stimulating Keratinocyte Proliferation and Migration in Chronic Wounds","volume":"10","author":"Alcaraz","year":"2015","journal-title":"PLoS ONE"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1007\/s00441-012-1424-6","article-title":"Amniotic membrane: From structure and functions to clinical applications","volume":"349","author":"Mamede","year":"2012","journal-title":"Cell Tissue Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1097\/TA.0000000000003050","article-title":"Efficacy and feasibility of amniotic membrane for the treatment of burn wounds: A meta-analysis","volume":"90","author":"Yang","year":"2021","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Lipov\u00fd, B., Hlad\u00edk, M., \u0160toura\u010d, P., and Forostyak, S. (2021). Case Report: Wound Closure Acceleration in a Patient With Toxic Epidermal Necrolysis Using a Lyophilised Amniotic Membrane. Front. Bioeng. Biotechnol., 9.","DOI":"10.3389\/fbioe.2021.649317"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1007\/s10561-015-9520-y","article-title":"Amniotic membranes in ophthalmology: Long term data on transplantation outcomes","volume":"17","author":"Paolin","year":"2016","journal-title":"Cell Tissue Bank."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1007\/s10561-022-10002-y","article-title":"Cryopreservation of human amniotic membrane for ocular surface reconstruction: A comparison between protocols","volume":"23","author":"Lamon","year":"2022","journal-title":"Cell Tissue Bank."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1093\/milmed\/usaa299","article-title":"Evaluation of Fluorescent Light Energy for the Treatment of Acute Second-degree Burns","volume":"186","author":"Mellergaard","year":"2021","journal-title":"Mil. Med."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Stru\u017cyna, J., Surowiecka, A., Korzeniowski, T., Korulczyk, P., Drozd, L., Stachura, A., Torres, K., and Krajewski, A. (2022). Accuracy of SCORTEN in predicting mortality in toxic epidermal necrolysis. BMC Med. Inform. Decis. Mak., 22.","DOI":"10.1186\/s12911-022-02013-2"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1097\/01.BCR.0000216532.71360.9B","article-title":"SCORTEN Overestimates Mortality in the Setting of a Standardized Treatment Protocol","volume":"27","author":"Imahara","year":"2006","journal-title":"J. Burn. Care Res."}],"container-title":["European Burn Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2673-1991\/7\/3\/37\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T16:44:30Z","timestamp":1783529070000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2673-1991\/7\/3\/37"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,8]]},"references-count":17,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["ebj7030037"],"URL":"https:\/\/doi.org\/10.3390\/ebj7030037","relation":{},"ISSN":["2673-1991"],"issn-type":[{"value":"2673-1991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,8]]}}}