Toxic Epidermal Necrolysis following Antiepileptic Therapy: A Case Report and review of Supportive Care Strategies

Abstract

Background: Toxic Epidermal Necrolysis (TEN) is a rare, life-threatening mucocutaneous reaction, most commonly triggered by medications. Characterized by widespread epidermal detachment and mucosal involvement, TEN closely resembles severe burn injuries in both clinical presentation and pathophysiology, including risks of fluid loss, sepsis, and multi-organ failure.

Case Report: We report a case of a 36-year-old female with a known history of epilepsy, who developed TEN following the administration of Carbamazepine, an antiepileptic drug introduced after a recent seizure episode. Within days, the patient presented with high-grade fever, facial edema, and painful, fluid-filled skin lesions that rapidly progressed across the body, along with mucosal and ocular involvement. Laboratory findings revealed leukocytosis, elevated CRP and ESR levels, and electrolyte imbalances.

Discussion: The patient was treated with a multidisciplinary approach including immediate withdrawal of the offending drug, immunosuppressive therapy with intravenous dexamethasone, symptomatic relief, intensive wound care, ocular protection, electrolyte correction, nutritional support, and psychiatric evaluation. Gradual improvement was noted, and corticosteroids were tapered and discontinued after one week. The comprehensive supportive care approach led to stabilization and eventual recovery.

Conclusion: This case underscores the importance of early identification and withdrawal of the causative drug in suspected TEN cases, followed by aggressive supportive care. Although specific pharmacological treatments such as corticosteroids are used, their efficacy remains controversial, and supportive management remains the cornerstone of therapy. A coordinated, interprofessional approach is essential for improving patient outcomes in TEN.

Keywords: TEN, Carbamazepine, Drug induced reaction, multi faceted management approach