Ciprofloxacin-induced toxic epidermal necrolysis

OBJECTIVE: To report a case of probable ciprofloxacin-induced toxic epidermal necrolysis (TEN) in an adult with systemic lupus erythematosus (SLE). CASE SUMMARY: A 31-year-old woman with SLE developed a pruritic rash following her first dose of oral ciprofloxacin. She continued taking ciprofloxacin, and the rash progressively worsened, becoming painful and covering her entire body. She discontinued the ciprofloxacin six days later and presented to the hospital, where two days later, her rash began to desquamate with epidermal erosions and a positive Nikolsky's sign. Skin biopsy was positive for TEN. She then was transferred to a burn-treatment unit because of the severity of the skin involvement. The patient recovered following prolonged hospitalization and rehabilitation. CONCLUSIONS: Although TEN occurs rarely with ciprofloxacin, extensive postmarketing surveillance needs to be performed to determine other risk factors for its development and to establish the incidence of TEN and other severe cutaneous reactions caused by ciprofloxacin or the other fluoroquinolones.

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