Case Presentation
A 60-year-old female, a known case of Hypertension and Chronic Kidney
Disease presented to Emergency Department with generalized ill-defined
confluent dusky erythematous tender patches and flaccid bullae on the
trunk and extremities with peeling of skin over the mammary region for 3
days (fig 1D-F). She had erosions on lips, hard palate, and mucopurulent
discharge from the eyes. Skin lesions developed after 16 hours of intake
of the last dose of Furosemide as advised by the treating physician for
facial puffiness and pedal edema.
Nikolsky’s sign was positive. Body Surface Area involved was
approximately 40% and she was hemodynamically stable. Blood
investigations revealed raised Serum BUN (106.6 mg/dl), raised
creatinine (4.6 mg/dl), and hypokalemia (2.9 meq/l). Arterial Blood Gas
analysis showed decreased pH (7.24) and bicarbonate levels (12meq/l).
Diagnosis of TEN with Acute on Chronic Kidney Disease and Metabolic
Acidosis was made with baseline SCORTEN 5. She was admitted to ICU and
was administered intravenous fluids, antibiotics, and parenteral
hydrocortisone along with mucocutaneous care. SCORTEN was 5 on the
3rd day of admission. Initial reepithelialization of
skin lesion was observed after 7 days (fig 2A-C) and was completed by
Day 15 (fig. 2D-F).
The patient had a similar episode of skin lesions 3 years back following
intake of Nimesulide for myalgia and developed extensive mucocutaneous
lesions as compared to the second episode (fig. 1A-C). She was admitted
to our hospital during the previous episode and was managed
successfully.