LAUSR

We were pleased to read the additional commentary on ou article by Khurana et al.1 with the insight of adding pro calcitonin as a serum marker for sepsis in severe epiderm necrolysis (EN) patients. In many patients fever is attributed to the general inflam matory chaos of EN. Since prophylactic antibiotic therapy not a standard routine and some patients have fever as a isolated infection signal, it seems reasonable to adopt a lab oratory test to evaluate the likelihood of sepsis in patien with tachycardia, fever, or any other laboratory or clinic sign of infection not prompting antibiotic therapy. Thus, pro calcitonin may be most helpful in the context of the initi expectant approach. A positive result should prompt chang in intervention, and a negative result would be reassuring Hypothermia, on the other hand, could be a more specifi clinical sign of sepsis. However, it is known to be assoc ated with poor prognosis.2 Recently, procalcitonin > 1 g/ and also hypothermia were associated with positive bloo cultures in EN patients.3 Despite the presence of sepsis, therapeutic immuno suppression must not be delayed in patients with hig SCORTEN. During the chart review4 some fatal cases wer not prescribed systemic immunosuppression because of th possibility of sepsis, in a period of clinical decision pre ceding SCORTEN. Many of those patients could have had different outcome if clinicians were aware that predictio of death was the most likely event according to SCORTEN, game-changer in the treatment of EN.