Trimethoprim/sulfamethoxazole-induced toxic epidermal necrolysis

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) associated with trimethoprim/sulfamethoxazole (TMP/SMX). CASE SUMMARY: A 34-year-old Asian woman developed a severe, desquamating mu cocutaneous reaction (TEN) after six days of taking TMP/SMX to treat a pres umed urinary tract infection (UTI). DISCUSSION: TMP/SMX is often recommended as first-line therapy for UTIs, si nusitis, bronchitis, and as prophylaxis and treatment for Pneumocystis cari nii pneumonia. TEN is a rare, but severe condition associated with sulfonam ide use. This article describes a typical case and offers an opportunity fo r review of this potentially serious reaction. CONCLUSIONS: Sulfonamides are often implicated in the majority of drug-indu ced cases of TEN. This case report illustrates the typical presentation of sulfonamide-induced TEN with a prodrome, characteristic rash, mucous membra ne lesions, and systemic involvement. Practitioners should be aware of this rare adverse effect and closely observe patients for cutaneous manifestati ons or complaints. Any suspected drug should be discontinued if clinical ev aluation leads to the suspicion of Stevens-Johnson syndrome or TEN.