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Caspofungin-induced severe toxic epidermal necrolysis
Ming-Chia Lee1, Ya-Wen Ni, Chun-Hua Wang
1Department of Pharmacy, Buddhist Tzu Chi General Hospital, Taipei Branch, Taipei, Taiwan.
The Annals of Pharmacotherapy
|April 22, 2010
Summary
This case report details a patient who developed toxic epidermal necrolysis (TEN), a severe skin reaction, after receiving the antifungal medication caspofungin. Healthcare providers should monitor for early TEN symptoms in patients treated with caspofungin.
Area of Science:
- Dermatology
- Infectious Diseases
- Clinical Pharmacology
Background:
- Candidemia is a serious bloodstream infection often requiring antifungal treatment.
- Fluconazole-resistant Candida krusei necessitates alternative antifungal agents.
- Caspofungin is an echinocandin antifungal used for invasive candidiasis.
Observation:
- An 86-year-old male developed disseminated Candida krusei infection post-fracture surgery.
- Initial fluconazole treatment failed; caspofungin was initiated.
- Recurrence of sepsis led to a second caspofungin dose, precipitating severe skin reactions consistent with TEN.
Findings:
- The patient experienced a probable adverse drug reaction to caspofungin, diagnosed as toxic epidermal necrolysis (TEN).
- The Naranjo probability scale indicated a probable link between caspofungin and TEN development.
- Despite supportive care, the patient succumbed to refractory shock.
Implications:
- This is the first reported case of caspofungin-induced TEN.
- Clinicians must be vigilant for early signs of TEN in patients receiving caspofungin.
- Awareness of this rare but severe adverse reaction is crucial for patient safety.
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