UNDESIRABLE DRUG EFFECTS AFTER TAKING CHLORMEZANONE (MUSKEL TRANCOPAL(R)) WITH LETHAL OUTCOME

History and clinical findings: A 34-year-old woman was admitted for tr eatment of toxic epidermolysis of the skin and mucosa. 16 days previou sly she had started to take chlormezanone (Muskel Trancopal(R)) and so me other medications for pain in the shoulder and neck. On admission s he had a fever of 39 degrees C and, in addition to the epidermolysis, diffuse abdominal pain on pressure and blood-streaked stool. Investiga tions: Liver enzyme activities (GOT 979 U/l, GPT 1496 U/l, gamma GT 20 1 U/l) alkaline phosphatase 515 U/l), bilirubin (3.9 mg/dl) and pancre atic enzyme activities were raised. Sonography was nondiagnostic, comp uted tomography demonstrated only a small amount of ascites. Treatment and course: The epidermolytic lesions, cholestatic hepatitis and panc reatitis markedly regressed under aseptic wound treatment, antibiotics and parenteral nutrition. Persistent blood-streaked stools and bilate ral pneumonia with progressive respiratory failure developed. Despite intensive medical care the patient died after 14 days from protracted sepsis with multi-organ failure. Autopsy additionally revealed adult r espiratory distress syndrome and complete loss of colonic mucosa. Conc lusion: The severe course of a toxic epidermal necrosis with fatal out come is the first such case reported in Germany that very probably was caused by chlormezanone. 4 weeks after this case was reported to the German Doctors' Drug Commission, the manufacturers of the drug withdre w it from the market.