J Rheum Dis.  2013 Dec;20(6):374-377. 10.4078/jrd.2013.20.6.374.

Toxic Epidermal Necrolysis by Ceftriaxone in Patient with Newly Diagnosed Systemic Lupus Erythematosus

• Lee JH
• Ju IN
• Cho HJ
• Min HK
• Hong YS

• KMID: 2222997
• DOI: http://doi.org/10.4078/jrd.2013.20.6.374

Abstract

Toxic epidermal necrolysis (TEN) is a rare disease in absolute numbers with an incidence of 2 cases per million people per year. Most cases of TEN are caused by drugs, but certain infectious diseases may have an impact on the risk. There are rare reports of TEN occurring without history of drug ingestion in systemic lupus erythematosus (SLE), appearing similar to cutaneous lupus and early TEN manifestations, such as erythema multiforme. This report describes a patient with SLE who presented with manifestations of TEN after ceftriaxone treatment. The patient was newly diagnosed with SLE and TEN occurring eight days after cessation of ceftriaxone. Considering possible etiologies, we could not exclude ceftriaxone as the cause of TEN. After intravenous immunoglobulin with glucocorticoid, clinical symptoms improved.

Keyword

Systemic lupus erythematosus; Toxic epidermal necrolysis; Ceftriaxone; Hydroxychloroquine; IV immunoglobulin

MeSH Terms

Ceftriaxone*
Communicable Diseases
Eating
Epidermal Necrolysis, Toxic*
Erythema Multiforme
Humans
Hydroxychloroquine
Immunoglobulins
Incidence
Lupus Erythematosus, Systemic*
Rare Diseases
Ceftriaxone
Hydroxychloroquine
Immunoglobulins

Figure

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  Figure 1. It shows blistered skin lesions in back (A) and upper abdomen (B).

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  Figure 2. It shows skin detachment and new epidermis regeneration. Skin detachment start in back at hospital day 22 (A). Around hospital day 30, almost skin detachment is over and new epidermis go into new regeneration (B).

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  Figure 3. It shows skin pathology stained haematoxylin eosin. Epidermis separate from subepidermal layer (A, ×100). Several vacuo-lization were observed in subepidermal layer (B, ×400). Because total seperat-ion from dermal- epidermal junction, it is difficult to observe the vacuolar alteration and solitary necrotic kerati-nocyte. How-ever, it is not observed that moderate to dense periadnexal and perivascular lymphocyte infiltration consistent with SLE.

Reference

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