Learning objectives Present a case of toxic epidermal necrolysis in the UAE who was found to have mycoplasma pneumoniae respiratory infection. Case summary A 4-year-old girl, previously healthy, presented with fever of 3 days with a rash for 1 day. The rash was erythematous, sand paper like involving her chest, back, upper and lower extremities. She was found to have streptococcal pharyngitis, treated as a case of scarlet fever and discharged home on Amoxicillin-Clavulanate acid and ibuprofen.The next day, she presented again with fever and increasing rash that is now involving the eyes and mouth (lips an oral mucosa). The rash was evolving to erosions and sloughing of the skin on the chest and back.Considering that her skin involvement was tremendous (> 30%), she was diagnosed as toxic epidermal necrolysis (TEN). She was admitted to the pediatrics intensive care unit (PICU).When looking for the underlying cause, the triggering factor was suspected to be either drug related or infection related. She was tested for mycoplasma infection that turned out to be positive, and she was managed with azithromycin.Throughout her illness she was hemodynamically stable, on the 4 th day of illness she started to improve in sense of settling fever and tachycardia, Her inflammatory markers were decreasing as well.She continued her medical care in the hospital for 20 days and discharged home with follow-ups. Methods Case report and literature review Discussion We believe as clinicians that in the UAE we rarely encounter such critical cases that warrant a multidisciplinary approach, aiming to deliver the best care and maintain the well being of the patient. In reviewing the literature there was no reported case in the UAE. Moreover, etiological underlying factors are clearly known in the medical history. We believe that three factors were implied in this case; Amoxicillin use, mycoplasma pneumoniae respiratory infection and the possibility of genetic predisposition. Conclusion SJS/TEN is a challenging diagnosis, that merits prompt recognition and management hoping to prevent its sequelae. Many factors contribute to the development of these unpleasant and eventful diagnoses. Pediatricians need to be alerted regarding this diagnosis and the available management modalities.

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