Amlodipine-induced toxic epidermal necrolysis

Area of Science:

• Dermatology
• Pharmacology
• Nephrology

Background:

• Diabetic nephropathy and hypertension are common comorbidities.
• Enalapril was initially prescribed for renal dysfunction and hyperkalemia.
• Amlodipine, a dihydropyridine calcium channel blocker, was initiated as an alternative treatment.

Observation:

• A 71-year-old woman developed a pruritic rash on day 12 of amlodipine therapy.
• The rash progressed to involve 25% TBSA with hives and blisters, necessitating transfer to a burn center.
• Conjunctival sloughing was noted, and the rash ultimately involved 48.5% TBSA.

Findings:

• This is the first reported case of amlodipine-induced toxic epidermal necrolysis.
• The Naranjo assessment indicated a probable adverse drug reaction (score of 5).
• The SCORTEN score was 4, predicting a 58% mortality.

Implications:

• Amlodipine should be considered a potential cause of severe dermatotoxicity, including toxic epidermal necrolysis.
• Clinicians should be aware of rare but serious cutaneous adverse reactions associated with calcium channel blockers.
• This case expands the known spectrum of drug-induced skin reactions and emphasizes careful medication monitoring.