Toxic epidermal necrolysis (TEN) is a life-threatening mucocutaneous disease with high mortality. Dithiocarbamates (DTC) are organosulphur compounds widely used in agriculture, industry and households. We report a case of TEN after exposure to mancozeb in fungicide. A 48-year-old 75 kg b.w. man was admitted with fever and generalized skin/mucous lesions after application of fungicide in a home garden. The patient had necrotic desquamation of gastrointestinal/respiratory tract mucosa, ocular lesion and skin epidermolysis of 90% of body surface. The laboratory findings included elevation of inflammatory parameters, hyperglycaemia, increased urea, creatinine, liver enzymes, hypoalbuminemia and electrolyte disturbances. The treatment included supportive care, management of fluid/electrolyte requirements, analgesics and enteral nutrition. Skin lesions were treated with occlusive non-adhesive biological wound dressings. Due to the proof of Acinetobacter, Escherichia coli and Escherichia faecalis from skin swabs, a combination of meropenem with amikacin was administered. During the next 2 weeks, complete re-epithelialization of skin lesions occurred, mucosal lesions healed and the laboratory parameters returned to normal. The patient was discharged on day 42. TEN is a rare condition that is generally caused by medications. Nevertheless, high attention should be paid to the cases of occupational or household exposure to DTC fungicides widely used in agriculture and home gardens because of their ability to cause TEN after skin and inhalation exposure. Greater emphasis on the hazardous properties of these products is necessary to ensure non-professional users are aware of the necessity of protective clothing during mixing, loading, application and early re-entry into treated fields.Toxic epidermal necrolysis (TEN), or Lyell's syndrome, is an acute life-threatening mucocutaneous disease with an epidermal loss of more than 30% of the body surface area and the involvement of at least two mucosal surfaces comprising ocular, oral and genital [1,2]. It is a rare condition with an incidence of 0.4-1.2 cases per million persons per year, but with a high mortality rate of 30-50% [3][4][5]. The morbidity and mortality result not only from the extensive denuded skin areas but also from the visceral involvement -particularly in the gastrointestinal and respiratory systems -sepsis, and multiple organ failure [6].The mechanism of TEN is not fully understood, but it appears to be the activation of autoimmune hypersensitivity reaction by the causative agents or their metabolites, as rechallenging an individual with the same agent can result in rapid recurrence of TEN [7,8]. The histopathology of skin lesions shows that keratinocyte apoptosis followed by necrosis is the pathogenic basis of the widespread epidermal detachment observed in TEN [9].Medications are the most frequent triggers of TEN, and more than 100 drugs have been implicated, including antibacterial sulphonamides, aromatic anticonvulsants, allopurinol, oxicam nonst...
