Woman died of ‘one in million’ toxic reaction
Dermatologist tells inquest once the TEN rash has begun, it cannot be stopped
Dublin Coroner’s Court heard that Nora Brew died after suffering a severe toxic reaction
Garreth Nauthon
Fri, Apr 18, 2014, 01:01
First published: Fri, Apr 18, 2014, 01:01
A Dublin woman died after developing a “one in a million” reaction to medication which left her with a toxic rash across 95 per cent of her body, an inquest has heard.
Nora Brew (80), Greenlea Road, Terenure, died at St James’s Hospital on December 8th, 2012.
She had been transferred to the burns unit after developing toxic epidermal necrolysis (TEN), a rare condition which causes the top layers of the skin to die.
Consultant dermatologist Dr Maureen Connolly told the inquest yesterday there was no way of stopping TEN once it had begun; it could be fatal depending on age and health.
Dublin Coroner’s Court heard that Ms Brew was initially diagnosed with ANCA positive vasculitis causing kidney failure in October 2012. This condition is also rare, affecting eight out of 100,000 people. She was put on immunosuppressants and antibiotic Septrin to prevent infection, along with a number of other medications.
Her family brought her to Tallaght A&E on November 19th after she developed a drug rash. Dr Connolly said that she believed the rash was most likely the result of the Septrin and this was immediately stopped. At this stage Ms Brew was not showing symptoms of TEN, she said.
Condition worsened
She was discharged from hospital on November 23rd. However, over the following days her condition worsened significantly and she returned to Tallaght A&E on November 27th where she was diagnosed with TEN due to Septrin.
The rash had changed in appearance with the skin blistering and affecting the mouth, Dr Connolly said. Ms Brew was transferred to the burns unit at St James’s where staff attempted to treat her using paraffin gel and skin substitutes. However, the rash became more extensive and she died on December 8th, 2012.
Dr Connolly said the chances of developing TEN were “one in a million” and that Septrin was more likely the cause rather than other medications Ms Brew was taking.
“The most important thing is to stop the medication,” she said. “That was done. There is no way of stopping it from progressing. I wish we had but we still have no good treatment for TEN.”
At post-mortem, pathologist Dr Nairi Tchrakian said the entire body had been wrapped in padded bandages with the exception of the eyes, nose and mouth. Lesions, blistering, epidermal exfoliation and ulceration was noted on 95 per cent of the body.
She gave cause of death as complications of “toxic epidermal necrolysis, a condition that results in massive fluid losses, hypothermia, increased susceptibility to infection and, ultimately, multi-organ failure”.
Reasonable doubt
Coroner Dr Brian Farrell said it was not possible to say beyond a reasonable doubt that Septrin had caused the rash but on the balance of probablities, it was the likely agent.
He recorded the death as an adverse drug reaction in a narrative verdict outlining the facts. He will also write to the Irish Medicines Board to alert it to the case.
Following the inquest, Eithne Brew said that people should be aware of the “devastating” side effects of many medical drugs.
“The horrific death of our mother will haunt our entire family forever. Nora was a beautiful, glamorous woman who took great pride in her appearance. In the end she had a closed coffin and her siblings did not even get to say a final goodbye,” she said.
