Toxic epidermal necrolysis associated with acetaminophen ingestion

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with acetaminophen ingestion. SUMMARY: A seven-year-old girl developed TEN after acetaminophen ingestion. The diagnosis was based on clinical evaluation and skin biopsy. A later ac etaminophen challenge, undertaken by an allergist who questioned the diagno sis, resulted in a similar skin reaction. DISCUSSION: TEN is a severe disease with a high mortality rate. TEN may be either idiopathic or associated with several clinical conditions, such as v iral infections, autoimmune disorders, malignancy, and drug hypersensitivit y. Because of the rarity of its association with acetaminophen, the diagnos is in our patient was questioned by an allergist who performed an oral acet aminophen rechallenge test despite the potential risk. This caused a severe skin reaction that required rehospitalization. CONCLUSIONS: TEN can be caused by over-the-counter medications such as acet aminophen. Rechallenge with the causative drug carries a risk of severe com plications and should be avoided.