Toxic Epidermal Necrolysis: Case Report and Review

Abstract

BACKGROUND: Stevens–Johnson syndrome and toxic epidermal necrolysis (TEN) are severe mucocutaneous adverse drug reactions primarily caused by drugs. Characterized by fever, prodromal symptoms, and extensive epidermal sloughing with mucous membrane involvement (>90%), they are collectively termed epidermal necrolysis and are considered a disease continuum. CASE PRESENTATION: A 65-year-old man presented with widespread erythema and distinctive target-like lesions, accompanied by ruptured flaccid vesicles on the extremities. Following a 4-week carbamazepine treatment for a previous cerebrovascular insult, hematological analysis revealed abnormalities. A multidisciplinary team, including a neurologist, endocrinologist, and ophthalmologist, prescribed a 3-day course of intravenous immunoglobulin at 0.5 g/kg and an initial dose of 300 mg prednisolone for 3 days, supported by additional therapy. Discharged after 3 weeks, the rash completely resolved within 2 months. CONCLUSION: TEN, a severe mucocutaneous condition with a 30% mortality rate, often results from drug exposure. Swift identification of the causative drug is crucial for optimal outcomes. Treatment primarily includes discontinuing the offending drug and offering supportive care for mucocutaneous lesions. A multidisciplinary approach is vital based on organ system involvement. The effectiveness of pharmacological treatments, such as intravenous immunoglobulin and corticosteroids, is continually under evaluation.