Phenytoin-induced Lyell's syndrome

Abstract

Lyell's syndrome or toxic epidermal necrolysis (TEN) is a rare dermatological disease that causes serious morbidity and mortality. It is most commonly drug induced. The authors report the case of a 57-year-old woman who was admitted to our hospital with severe rash all over the body. She had been previously submitted to brain surgery for total resection of a large meningioma and medicated with phenytoin for seizures prophylaxis. During this treatment, erythematous lesions and blisters were observed first on her face and trunk and then spreading to the entire body. Detachment of the skin, as well as mucous involvement especially of mouth and conjunctiva, was also observed. TEN was diagnosed, and phenytoin was discontinued. Intravenous fluids, systemic steroids and tightened infection control measures were implemented. After 10 days, skin recovery and re-epithelialisation were established, temperature decreased and mucosal complications stabilised. The patient was discharged after 1 month of hospitalisation.

Figure 1

Oral and ocular involvement in toxic epidermal necrolysis.

Figure 2

Widespread erythema and confluent vesiculation leading to sloughing of the skin in toxic epidermal necrolysis.

Figure 3

Diffuse erythema and large areas of desquamation in toxic epidermal necrolysis.

Figure 4

Multiple bullae overlying diffuse erythema in toxic epidermal necrolysis.