Severe toxic epidermal necrolysis precipitated by amphetamine use.
A 48-year-old man presented with a maculopapular truncal rash 9 days following intravenous amphetamine use. He subsequently developed widespread bullae over his trunk and upper limbs. Treatment was initially commenced with intravenous hydrocortisone. A diagnosis of toxic epidermal necrolysis was made and the treatment was changed to intravenous immunoglobulin at a lower dose than requested. At the height of the reaction, there was 90% body surface area involvement with tri-mucosal involvement. His response to the intravenous immunoglobulin was poor and was complicated by infection with methicillin-resistant Staphylococcus aureus, Candida albicans and Pseudomonas aeruginosa. Gradual re-epithelialization took place over the next 6 weeks.
Roberts
Hugh
H
Department of Dermatology, Alfred Hospital, Prahan, Victoria, Australia. hughroberts1@bigpond.com
Chamberlain
Alexander
A
Rennick
Gordon
G
McLean
Catriona
C
Gin
Douglas
D
D000662:Amphetamines / Q000008:administration & dosage / Q000009:adverse effects*; D003937:Diagnosis, Differential; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012720:Severity of Illness Index; D013203:Staphylococcal Infections / Q000150:complications; D013262:Stevens-Johnson Syndrome / Q000150:complications / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D015819:Substance Abuse, Intravenous
D000662:Amphetamines