Toxic epidermal necrolysis as a rare and potentially fatal form of complication of systemic lupus erythematosus

Abstract

Toxic epidermal necrolysis is an entity characterized by detachment of the epidermis. Its most described etiology is drug, it is also associated with other causes, mainly in patients who manifest an inadequate immune response. Systemic lupus erythematosus has been interpreted as a possible etiological cofactor, being an atypical presentation and difficult to manage. We present a case of a 54-year-old female with a history of systemic lupus erythematosus and abandonment of her treatment, was admitted due to acute diarrheal symptoms and 48 hours later she started with disseminated ulcerocostrous skin lesions with generalized epidermal detachment, severe eye damage and positive Nikolsky's sign. Despite the measures taken, she died 72 hours after being diagnosed due to septic shock. The case is presented because the epidermal toxic necrolysis that occurred as an infrequent and potentially fatal complication of systemic lupus erythematosus in a hospital with little experience in the care of these patients. The presence in this case of this dermatological disease, the absence of an obvious cause and a history of untreated lupus led us to consider that the patient manifested this severe dermatopathy as a complication of her underlying disease.