Treatment of toxic epidermal necrolysis in a patient with extensive skin damage induced by dimethyl N-cyanodithioiminocarbonate: a case report

Introduction: Dimethyl N-cyanodithioiminocarbonate is a sulfur-containing industrial compound known to induce severe cutaneous reactions, including toxic epidermal necrolysis (TEN). Current management primarily focuses on immunomodulation, yet there is a recognized gap in standardized wound and systemic care for extensive, sepsis-complicated cases. This report describes a rarely documented case of dimethyl N-cyanodithioiminocarbonate-induced TEN involving over 90% of the total body surface area (TBSA) complicated by wound sepsis, and represents the application of a major-burn treatment protocol for this specific chemical-induced condition. Case presentation: A 43-year-old male chemical plant worker presented with rapidly progressing skin detachment covering 92% TBSA and mucosal involvement, following occupational exposure without adequate protection. After initial dermatological management failed to prevent clinical deterioration, he was transferred to a burn intensive care unit (BICU). A multidisciplinary burn-oriented strategy was implemented, including: precise fluid resuscitation, gradual tapering of systemic corticosteroids, use of an air-fluidized bed, topical nano-silver dressings with compound purple grass oil, targeted antibiotics, and intensive nutritional support. Within two weeks, complete re-epithelialization was achieved without surgical intervention, and all infection markers normalized. Conclusions: The integration of burn-critical care principles-particularly structured fluid resuscitation, pressure-offloading, and moist wound management-into the treatment of severe chemical-induced TEN can facilitate rapid wound closure and systemic recovery even in high-mortality-risk cases. This case supports the adoption of a multidisciplinary, burn-informed approach for extensive TEN and underscores the need for heightened occupational safety measures when handling potent sensitizers such as dimethyl N-cyanodithioiminocarbonate.