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Background: Toxic epidermal necrolysis (TEN, Lyell disease) is characterized by a widespread bullae formation with epidermal necrosis. TEN occurs mainly in adults, is often attributable to drug sensitivity, and results in full-thickness damage to the epidermis. It is associated with considerable morbidity and mortality.
Case report: A 54-year-old man was diagnosed as having small-cell lung cancer. Phenytoin was administered 300 mg once a day for seizure prophylaxis, after completion of cranial radiotherapy due to solitary brain metastasis. Twelve days after commencing this drug he developed high fever, facial bullae, generalised cutaneous erythematous macules, and targetoid lesions. A skin punch biopsy was performed, and the pathological diagnosis was TEN. The patient was considered to be suffering phenytoin-induced TEN, occurring in up to 80% skin involvement. Complete recovery was achieved after treatment with systemic corticosteroids and antibiotics for septicemia with minimal permanent sequela.
Conclusion: As the first suspicious sign is seen, phenytoin should be discontinued immediately and aggressive medical management should be started.