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Case report
Vajra Bhasma, Ayurvedic medicine: a rare and unusual cause of Lyell’s syndrome and its successful management
  1. Shivakumar M Channabasappa1,
  2. Bhavna Gupta2 and
  3. Shruthi Dharmappa3
  1. 1Anaesthesiology, Subbaiah Institute of Medical Science, Shimoga, Karnataka, India
  2. 2Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India
  3. 3Department of Oral Pathology and Microbiology, Subbaiah Institute of Dental Sciences, Shimoga, Karnataka, India
  1. Correspondence to Dr Bhavna Gupta; bhavna.kakkar{at}


Toxic epidermolysis necrosis (TEN) or Lyell syndrome is a potentially life-threatening immunological adverse skin disease, which mostly occurs secondary to the intake of an offending drug. It commonly manifests as a widespread exfoliating bullous lesion in skin and mucous membrane mimicking superficial burns and may result in hypovolemic and/or septic shock. Authors report an unusual case of Lyell’s syndrome in a 42-year-old woman, secondary to the intake of Ayurveda medicine ‘Vajra Bhasma’ (Diamond Ash) prescribed by an Ayurveda physician for treatment of her trigeminal neuralgia. After 8th day of continuous medication intake, she had prodromal illness and rapidly developing exfoliative skin lesion extended over 80% of total body surface area, breathing difficulty, dizziness and anuria. The case was successfully managed by timely diagnosis, adequate hydration and administration of immunoglobulins. After 17 days, the skin epithelium regenerated, and she improved clinically with some depigmented lesions at discharge, which were normalised without any sequel during her further follow-up visits in hospital. Identification and withdrawal of the suspected drug, adequate resuscitation and early immunoglobulin administration are critical in management of TEN.

  • resuscitation
  • pharmacology and therapeutics
  • unwanted effects / adverse reactions
  • skin
  • Adult intensive care

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  • Contributors SMC: concepts, design. BG: literature search, data acquisition. SD: manuscript draft. All authors: manuscript approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.