A case of toxic epidermal necrolysis in an elderly female patient

Toxic epidermal necrolysis is a rare, potentially fatal, and mainly drug-induced dermatological emergency that requires immediate medical intervention. It is characterized by extensive erythema, widespread sloughing of the epidermis and mucous membranes, and tissue necrosis. The condition can result in significant skin loss and serious complications such as sepsis and shock. With a mortality rate of 30%-50%, early recognition and prompt treatment are critical to improving outcomes. Here we report the case of an 85-year-old woman who presented to our emergency department with confluent erythematous maculopapular eruptions affecting more than 60% of her body surface area, accompanied by a positive Nikolsky sign and widespread areas of denuded skin, including involvement of the oral, vaginal, and anal mucosa following self-administered trimethoprim-sulfamethoxazole for a urinary tract infection. A skin biopsy revealed transepidermal necrosis with minimal active inflammation in the upper dermis. We initiated systemic glucocorticoid therapy along with fluid resuscitation. The patient remained stable throughout hospitalization. By the time of discharge, dermatological findings had significantly improved, and the skin was in the re-epithelialization phase. In conclusion, a high index of clinical suspicion for toxic epidermal necrolysis is necessary when a patient receiving trimethoprim-sulfamethoxazole presents with blistering and/or skin sloughing. Prompt treatment with immunosuppressive agents and supportive care is essential to improve outcomes.