A case of toxic epidermal necrolysis induced by losartan and furosemide in patient with chronic renal failure: case report

Abstract

Toxic epidermal necrolysis (TEN) is a serious and potentially fatal drug side effect in patients with chronic renal failure (CRF). This is the first report to show that losartan and furosemide induced TEN in a CRF patient. A 76-year-old man was administered losartan and furosemide for hypertension and leg edema. Nine days later, severe skin sores and ulceration were observed, and were diagnosed as drug-induced TEN. Drugs including losartan and furosemide were immediately stopped. However, renal function rapidly deteriorated. We started oral steroids and steroid pulse therapy. Since steroid therapy did not improve the progression of TEN, we performed plasmapheresis and administered an intravenous injection of immunoglobulin (IVIg) for oral infectious mucosal pus. The drug-induced lymphocyte stimulation test (DLST) for losartan and furosemide was positive. Here we report for the first time that losartan and furosemide induced TEN in a CRF patient. Drug-induced TEN may occur in patients with renal dysfunction because of reduced drug metabolism and/or polypharmacy in these patients. As such, care should be taken when selecting drugs for the treatment of CRF patients.