Toxic epidermal necrolysis and graft vs. host disease: a clinical spectrumbut a diagnostic dilemma

We describe a 53-year-old man who developed partial and full thickness skin loss associated with pyrexia, diarrhoea, liner, renal and bone marrow fail ure, during treatment for an aggressive B cell lymphoblastic lymphoma. The clinical features and histology were compatible with both toxic epidermal n ecrolysis and graft vs, host disease, causing a diagnostic and therapeutic dilemma. We discuss the possibility that methotrexate was the causative dru g, with review of its cutaneous side-effects, Histologically our patient de monstrated the spat-se dermal infiltrate with full thickness epidermal necr osis typical of toxic epidermal necrolysis and graft vs. host disease, We d iscuss this finding with respect to the pathogenesis of toxic epidermal nec rolysis.