Article Text

Unexpected outcome (positive or negative) including adverse drug reactions
Don’t live in a town where there are no doctors: toxic epidermal necrolysis initially misdiagnosed as oral thrush
  1. Abdul Majid Wani1,
  2. Waleed Mohd Hussain2,
  3. Mohamad Ibrahim Fatani2,
  4. Khaled Shawkat Ali2,
  5. Amer Mohd Khoujah3,
  6. Mubeena Akhtar2,
  7. Ghassan Adnan Al Maimani4,
  8. Sadeya Hanif Raja2,
  9. Ashraf Basraheel2,
  10. Khurram Fareed2
  1. 1
    Hera General Hospital, Emergency Medicine, 4a/201, Hera General Hospital, Makkah, Western, 21955, Saudi Arabia
  2. 2
    Hera General Hospital, Medicine, Hera Gen Hospital, Makkah, Western, 21955, Saudi Arabia
  3. 3
    Omul Qurah University, Medicine, Omul Qurah University, Makkah, 21955, Saudi Arabia
  4. 4
    Umm Al-Qura University, Umm Al-Qura University, Makkah, 21955, Saudi Arabia
  1. Abdul Majid Wani, dr_wani_majid{at}


Toxic epidermal necrolysis (TEN) is a rare but life threatening skin disease that is most commonly drug induced. The exact pathogenesis of TEN is still unknown and many drugs, including prednisolone, cyclosporin and intravenous immunoglobulin (IVIG), have been used in an attempt to halt the disease process. The use of IVIG in particular is controversial. Recently, the US Food and Drug Administration (FDA) has made a labelling change to the drug information for carbamazepine. Owing to recent data implicating the HLA allele B*1502 as a marker for carbamazepine induced Stevens–Johnson syndrome and TEN in Han Chinese, the FDA recommends genotyping all Asians for the allele. We present an interesting case of carbamazepine induced TEN which was confused with oral thrush, had no skin lesions on presentation, and had an excellent response to a 5 day course of methylprednisolone and high dose IVIG in combination.

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  • Competing interests: none.

  • Patient consent: Patient/guardian consent was obtained for publication