Abstract
According to Lyell, drug-induced toxic epidermal necrolysis (TEN) is a potentially fatal skin disorder caused by drug hypersensitivity. It is characterized by the rapid development of clinical symptoms with high grade fever, Nikolsky's sign, vesicle formation, and erosion, and the histologic finding of epidermal loosening and necrosis. A patient is described who died 8 days after onset of drug-induced TEN, which was most likely due to nonsteroidal anti-inflammatory drugs ( NSAIDs) . The patient was a 38-year-old woman with a history of hypersensitivity to several drugs. The patient was simultaneously given a fosfomycin-group antibiotic ; a macrolide, clarithromycin ; and an NSAID by her local physician for the treatment of an upper respiratory infection. Eruptions of the face and trunk and a fever of 39°C developed approximately 3 days after the start of drug therapy (Fig. 1) . The patient was hospitalized owing to the development of severe pain in the epigastrium and increased severity of the skin eruption. Cardiac, pulmonary, and hepatic dysfunction, gastrointestinal bleeding, disseminated intravascular coagulation, and Nikolsky's sign were present on admission. TEN due to NSAIDs was suspected from the clinical course and was confirmed by histologic examination of a biopsy specimen (Fig. 2 and 3) . Diagnosis led to the start of steroid pulse therapy, plasma exchange, hemodialysis, granulocye colony-stimulating factor therapy, and other treatments. The patient died on the 5th hospital day despite these efforts (Table 1) . Findings at autopsy included bleeding in multiple organs. In addition, the mucosa of the gastrointestinal tract had diffusely sloughed and the lumen was filled with blood. Although its incidence is lower (0.4 %) than that of other skin eruptions, drug-induced TEN is potentially fatal. Patients must be observed carefully when drugs, especially NSAIDs, are administered.
