Martha R. Minera-Alejandro, Departamento de Medicina Interna, Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala
Carlos R. Salazar-Herrera, Departamento de Medicina Interna, Instituto Guatemalteco de Seguridad Social, Guatemala, Guatemala

Toxic epidermal necrolysis is a serious adverse reaction, which consists of generalized necrolysis of keratinocytes with inappropriate immune activation derived from medications or metabolites. We present the case of a male patient with no medical history, who 1 month prior to consultation was admitted to a private hospital for dengue without warning signs; however, during the initial clinical evaluation pneumonia was evident and ampicillin-sulbactam and analgesia with carbamazepine were administered, later on he began with an allergic reaction causing anaphylactic shock, which resolved in the first 24 hours and was discharged. 48 hours after discharge the patient began with a generalized cephalocaudal rash with papules > 1 cm, respiratory pattern deteriorated and he was placed under invasive mechanical ventilation. Skin cultures with Pseudomonas at the scrotal level and Staphylococcus epidermidis, on antibiotic coverage with cephalosporins, carbapenems and vancomycin. The patient died 2 months after admission. Toxic epidermal necrolysis is a dermatological emergency that causes significant morbidity and mortality, rapid diagnosis is essential to achieve optimal results. A better understanding of the diagnosis and treatment will lead to better management of the disease.

Keywords: Toxic epidermal necrolysis. Dermatological emergency. Adverse reaction. Adverse immune response. Drugs.