Toxic epidermal necrolysis associated with rifaximin

Area of Science:

• Hepatology
• Dermatology
• Pharmacology

Background:

• Hepatic encephalopathy is a serious complication of liver disease.
• Rifaximin is a commonly used antibiotic for hepatic encephalopathy.
• Severe cutaneous adverse drug reactions (SCARs) are rare but serious.

Observation:

• A 62-year-old woman with alcoholic hepatitis and hepatic encephalopathy was treated with rifaximin.
• After reinitiation of rifaximin therapy, the patient developed a diffuse, erythematous, maculopapular, and desquamating rash.
• The clinical presentation was consistent with toxic epidermal necrolysis (TEN).

Findings:

• The Naranjo scale suggested rifaximin as a possible cause of the severe cutaneous adverse drug reaction.
• Discontinuation of rifaximin and initiation of corticosteroids led to complete resolution of the rash.
• This case suggests a potential link between rifaximin and TEN in patients with liver disease.

Implications:

• Clinicians should be vigilant for severe cutaneous adverse drug reactions when prescribing rifaximin, especially in patients with compromised liver function.
• Further investigation may be warranted to understand the risk factors and mechanisms of rifaximin-induced TEN.
• This case underscores the importance of pharmacovigilance for even commonly prescribed medications.