Experimental staphylococcal toxic epidermal necrolysis (TEN) in adult humans and mice.

Abstract Newborn mice and young children are considered uniquely susceptible to staphylococcal toxic epidermal necrolysis, while older humans and mice are presumably more resistant. Twelve human volunteer subjects, injected intracutaneously with cell-free filtrates of phage Group II staphylococci purified by (NH 4 ) 2 SO 4 precipitation and ion exchange chromatography, developed spontaneous wrinkling or flaccid bullae over injection sites within 1 12 to 2 hours, and/or histologic evidence of cleavage limited to the lower granular layer from doses as low as 20 μg. Pretreatment of toxin preparations with rabbit antitoxin antiserum decreased subsequent titratable toxic epidermal necrolysis (TEN) activity. Organ cultures of skin from 8 additional adult humans revealed that hairy skin was as susceptible as nonhairy skin, and that adult human skin is at least as susceptible to toxin in vitro as is newborn mouse (NBM) skin. The initial site of toxin action appeared to be intercellular by electron microscopy both in vivo and in vitro. Adult mice responded similarly to human adults, thus providing a convenient animal model. These studies demonstrate that (1) the same toxin which produces TEN in newborn mice also produces TEN in humans; and (2) normal adult humans and mice are potentially susceptible to staphylococcal TEN.