Which immunopathologic pathways are involved in the pathogenesis of toxic epidermal necrolysis (TEN)?

Updated: Jul 01, 2021
  • Author: Samantha P Jellinek-Cohen, PharmD, BCPS (AQ-ID); Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

There is evidence supporting several immunopathologic pathways leading to keratinocyte apoptosis in TEN, including the following:

  • Fas ligand activation on keratinocyte membranes leading to death receptor–mediated apoptosis9

  • Release of destructive proteins (perforin and granzyme B) from cytotoxic T lymphocytes (CTLs) generated from an interaction with cells expressing major histocompatability complex (MHC) class I10

  • Overproduction of T cell– and/or macrophage-derived cytokines (interferon-γ [INF-γ], tumor necrosis factor-α [TNF-α], and various interleukins)1112

  • Drug-induced secretion of granulysin from CTLs, natural killer cells, and natural killer T cells13

Precisely how the inciting agent triggers the proposed pathways is yet to be elucidated.


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