Don't live in a town where there are no doctors: toxic epidermal necrolysis initially misdiagnosed as oral thrush.
Toxic epidermal necrolysis (TEN) is a rare but life threatening skin disease that is most commonly drug induced. The exact pathogenesis of TEN is still unknown and many drugs, including prednisolone, cyclosporin and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of IVIG in particular is controversial. Recently, the US Food and Drug Administration (FDA) has made a labelling change to the drug information for carbamazepine. Owing to recent data implicating the HLA allele B*1502 as a marker for carbamazepine induced Stevens-Johnson syndrome and TEN in Han Chinese, the FDA recommends genotyping all Asians for the allele. We present an interesting case of carbamazepine induced TEN which was confused with oral thrush, had no skin lesions on presentation, and had an excellent response to a 5 day course of methylprednisolone and high dose IVIG in combination.
Hera General Hospital, Emergency Medicine, 4a/201, Hera General Hospital, Makkah, Western, 21955, Saudi Arabia.
Abdul Majid
AM
Wani
Waleed Mohd
WM
Hussain
Mohamad Ibrahim
MI
Fatani
Khaled Shawkat
KS
Ali
Amer Mohd
AM
Khoujah
Mubeena
M
Akhtar
Ghassan Adnan Al
GA
Maimani
Sadeya Hanif
SH
Raja
Ashraf
A
Basraheel
Khurram
K
Fareed