Toxic epidermal necrolysis in patient with malignant astrocytoma

Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneus adverse reaction, most commonly triggered by medication. Treatment in some aspects is still controversial.

Patient with malignant astrocytoma, treated with palliative radiotherapy, developed massive erythema with bullae. Patient suffered from tumor-related epilepsy, treated pharmacologically with carbamazepine. After dermatological consultation TEN was diagnosed. The bacterial growth tests from blood were Staphylococci positive. An antibiotic therapy was performed and carbamazepine was withdrawn. Cyclosporine was administered. After 2 weeks of treatment, skin changes vanished and patient's condition improved. TEN could not be omitted in diagnosis of extensive skin changes because the causative drug removal is crucial for survival and pharmacological treatment varies in similar conditions. TEN as a drug-related disease more likely occurs in severely ill patients.