A Case of Toxic Epidermal Necrolysis Caused by the Use of Trimethoprim Alone

Abstract

Toxic epidermal necrolysis (TEN) is a rare, acute, severe mucocutaneous reaction commonly presenting following medication use. Thorough history taking and clinical examination are key to early diagnosis and management; skin biopsy provides diagnostic confirmation. We present a 54-year-old man who developed a widespread erythematous rash soon after the use of trimethoprim for an episode of acute prostatitis. An initial diagnosis of Stevens-Johnson syndrome evolved into toxic epidermal necrolysis following the rapid progression of his condition to a severe, blistering, and desquamating rash affecting more than 60% of his body surface area and mucosa. Through careful management with best supportive care and clinical judgement regarding the role of pharmacological intervention, he made a steady recovery supported by the wider multidisciplinary team. This is one of the very few reports in the literature implicating trimethoprim alone as an etiological agent in a severe case of TEN.

An individual patient data meta‐analysis of wound care in patients with toxic epidermal necrolysis

“…Similarly, participants who underwent any debridement were allocated to the ‘debridement’ group. These debrided participants represented centres practising conservative wound care 35‐42 and centres where routine debridement is practised 29,32,43,44,45,46,47,48,49,50,51,52,53,54,55 …”

“…Similarly, participants who underwent any debridement were allocated to the 'debridement' group. These debrided participants represented centres practising conservative wound care [35][36][37][38][39][40][41][42] and centres where routine debridement is practised. 29,32,43,44,45,46,47,48,49,50,51,52,53,54,55 Where the data were not available in the article, the study authors were contacted via email/phone to provide this information.…”

Toxic epidermal necrolysis in hepatitis A infection with acute-on-chronic liver failure: Case report and literature review

“…Unfortunately, the rash worsened on the 10th day of admission, and the patient received an intravenous infusion of methylprednisolone (40 mg, bid) in combination with IVIG (10 g/day). Although there is no conclusive evidence that any interventions are more effective than conservative treatments, a recent case report found that as the patient's disease worsened, a gradual escalation of treatment protocol helped the patient recover from the disease (26). When the treatment is effective, the patient's skin lesions and erythema usually begin to recover within 3 days after starting the treatment (27).…”

“…The patient's condition was significantly improved within 48 h (33). In another case report from the United Kingdom, when the disease progressed, effectiveness was shown after the gradual escalation of the treatment protocol from oral prednisolone to intravenous hydrocortisone (26). For steroid therapy, the choice of hormones, the appropriate dosage, the ideal treatment time, and safety still need to be further explored in clinical research.…”