An Atypical Case of Toxic Epidermal Necrolysis Associated With Ceftriaxone

Toxic epidermal necrolysis (TEN) is a rare, life-threatening dermatologic emergency, most commonly triggered by adverse drug reactions. It is characterized by widespread epidermal necrosis, extensive skin sloughing, and frequent mucosal involvement. Here, we present a case of a 73-year-old male with a history of chronic obstructive pulmonary disease (COPD), sarcoidosis, chronic kidney disease, and gout, who developed TEN following ceftriaxone administration for suspected pneumonia. Unlike typical presentations, the patient exhibited widespread epidermal detachment involving 50-60% of total body surface area (TBSA) but lacked mucosal involvement. Diagnosis was confirmed via skin biopsy, which revealed full-thickness epidermal necrosis. Management included the immediate discontinuation of ceftriaxone, supportive care, and wound care strategies, which led to recovery. This case highlights an atypical presentation of TEN, emphasizing that extensive epidermal detachment, even in the absence of mucosal involvement, warrants consideration of TEN as a potential diagnosis. Given the extremely limited reports of ceftriaxone-induced TEN, this case contributes to growing awareness of its potential role in severe cutaneous adverse reactions.