44 一位1 歲6 個月大的幼兒，一個星期前鼻孔周圍出現糜爛紅斑

與滲出液，3 天前全身皮膚開始發紅脫皮（如圖），理學檢查

發現體溫38.9℃，並無發現淋巴結腫大，口腔黏膜和舌頭完整

無異常，根據以上所述，最可能的診斷為何？

 Toxic epidermal necrolysis

 Staphylococcal scalded skin syndrome

 Kawasaki syndrome

 Scarlet fever

B

Toxic epidermal necrolysis (also known as "Lyell's syndrome"^[1]T) is a rare, life-threatening dermatologicalcondition that is usually induced by a reaction to medications.^[2] It is characterized by the detachment of the top layer of skin (the epidermis) from the lower layers of the skin (the dermis) all over the body.

There is broad agreement in medical literature that TEN can be considered a more severe form of Stevens-Johnson syndrome, and debate whether it falls on a spectrum of disease that includes erythema multiforme.^[3][4] Some authors consider that there is an overlap between the two syndromes (usually between 10% and 30% of skin detachment).

45 承上題，以下的治療何者最適當？

全身皮膚清創術（debridement），之後給予支持療法

靜脈注射prostaphlin

靜脈注射免疫球蛋白（IVIG）

靜脈注射penicillin G

ANS B

prostaphlin: OXACILLIN