HETEROTOPIC OSSIFICATION AS A COMPLICATION OF TOXIC EPIDERMAL NECROLYSIS

The development of heterotopic ossification (HO) as a complication of toxic epidermal necrolysis (TEN) has not been previously reported. TEN , also known as Lyell's syndrome, is a rare but serious skin disorder that typically occurs after the administration of drugs, especially su lfonamides, barbiturates, phenytoin, and nonsteroidal anti-inflammator y agents. TEN is characterized by the development of large fluid-fille d bullae with separation of large sheets of skin. Complications of TEN can include extensive denudation of skin with dehydration and electro lyte abnormalities, gastrointestinal hemorrhage, acute tubular necrosi s, secondary infection of denuded skin, pneumonia, bacterial conjuncti vitis, keratitis, and septic infarcts of internal organs. We report a case of HO in a patient with TEN after treatment with trimethoprim-sul famethoxazole. A 49-year-old man developed an erythematous rash, bulla e, fever, and extensive skin loss consistent with a diagnosis of TEN. He was intubated for complications of TEN (pneumonia) and maintained o n bed rest for several weeks. In addition, he developed HO that result ed in multiple joint contractures. He was treated with aggressive rang e of motion by physical therapy, surgical resection of the HO followed by radiation to both elbows, right hip, and right knee. Postoperative outpatient rehabilitation enabled improved function in his mobility a nd activities of daily living. HO is known to occur after spinal cord and brain injuries and burns. It has not been reported to occur after TEN. Our experience with this case suggests that HO may merit inclusio n into the list of complications of TEN. (C) 1997 by the American Cong ress of Rehabilitation Medicine and the American Academy of Physical M edicine and Rehabilitation.