Toxic epidermal necrolysis in a child after carbamazepine dosage increment

Abstract

Toxic epidermal necrolysis is an uncommon but potentially life-threatening skin reaction that is frequently induced by drugs. The mucocutaneous reaction is characterized by bullous detachment of the epidermis and mucous membranes. We report a case of toxic epidermal necrolysis in a child receiving carbamazepine for 3 weeks; 60% of his body surface area was affected with mucosal involvement of the oropharynx, eyes, gastrointestinal system, and genitalia. His skin signs appeared 1 day after the last dosage increment. He was successfully treated with intravenous immunoglobulin and appropriate infection and wound management. The key to successful outcome includes early recognition, transfer to an intensive care center, prompt withdrawal of the causative agent, appropriate fluid resuscitation, and infection monitoring.