Severe antiretroviral therapy-induced toxic epidermal necrolysis in a child

Toxic epidermal necrolysis (TEN) is a rare and life-threatening condition characterised by extensive epidermal detachment and mucosal erosion. Adverse drug reaction is a strongly correlated causative factor and TEN is currently considered the most severe end of a spectrum of drug-induced mucocutaneous diseases, including Stevens-Johnson syndrome. Attaining an accurate and detailed patient history is critical for identifying potential causative agents, which can prove challenging; particularly in cultures such as that of Malawi. TEN lacks definitive management and the use of immunomodulation, such as with corticosteroids and intravenous immunoglobulin, remains controversial. We report a fascinating case of TEN associated with antiretroviral therapy. A 10-year-old female was given a combination of antiretroviral drugs (lamivudine, nevirapine and stavudine) as postexposure prophylaxis, having been raped. The child subsequently developed TEN and presented to our remote hospital in Malawi, where she was treated entirely with supportive therapy. This is an excellent example of difficult disease management in a limited-resource setting and provides reassuring evidence to clinicians of similar circumstance. To our knowledge, this is the first case report of antiretroviral therapy-induced TEN in a child.