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 3^rd 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.