title: Hydroxychloroquine-induced fatal toxic epidermal necrolysis complicated by angioinvasive rhizopus.
abstract: The majority of toxic epidermal necrolysis (TEN) cases are provoked by "high risk" medications (e.g. allopurinol, aromatic anticonvulsants, nevirapine, oxicam non-steroidal anti-inflammatory agents, and sulfonamides). TEN usually occurs 1 to 8 weeks after initial administration of the offending agent, but re-administration can evoke TEN within hours to days. Hydroxychloroquine has rarely been associated with TEN, with one case proving fatal. Herein, we report a case of hydroxychloroquine-induced fatal TEN complicated by angioinvasive Rhizopus. To our knowledge, this is the first case report of angioinvasive Rhizopus in a TEN patient. Initial misidentification of the offending agent causing TEN also serves as an important teaching point worth highlighting.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Cameron
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Word
authors.affiliation: University of Texas Southwestern Medical Center.
authors.forename: Arturo
authors.initials: A
authors.lastname: Dominguez
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000009:adverse effects*; D001808:Blood Vessels / Q000382:microbiology; D005148:Facial Dermatoses / Q000382:microbiology; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D006886:Hydroxychloroquine / Q000009:adverse effects*; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D009091:Mucormycosis / Q000150:complications* / Q000382:microbiology; D009336:Necrosis / Q000382:microbiology; D012233:Rhizopus; D012536:Scalp Dermatoses / Q000382:microbiology; D012867:Skin / Q000473:pathology; D013262:Stevens-Johnson Syndrome / Q000209:etiology*
chemical_list: D018501:Antirheumatic Agents; D006886:Hydroxychloroquine