Chronic Obstructive Pulmonary Disease: Open Access

We report what we believe is only the 6th reported case of toxic epidermal necrolysis (TEN) due to Cephalexin and the first to survive outside of a specialty care unit. The patient was a 50-year old female who presented with generalized cutaneous bullous and desquamative lesions one week after taking Cephalexin which exacerbated upon subsequent use. She had no known comorbidities and did not have any prior history of allergies. A predicted mortality rate of 35.3% (SCORTEN 3) was calculated based on the extent on epidermal detachment (76%), age, and low serum bicarbonate level of the patient. The patient survived in spite of admission to a charity non-communicable disease ward instead of an intensive care or specialty burn care unit. The bullous lesions were aseptically punctured and drained, a technique which was not used in any other documented case of TEN. Histologic findings of focal and complete portions of epidermal detachment, and aggregates of lymphoplasmacytic inflammatory cells confirmed epidermal necrolysis, a rare, life-threatening non Ig-E mediated hypersensitivity reaction to drugs. The pathophysiology of TEN is incompletely understood and there is uncertainty around its accepted management since the rarity of the disease and its high mortality rate makes it difficult to conduct randomised control trials on emerging therapies. Conservative and multidisciplinary approaches to medical management are discussed according to current literature.