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Norfloxacin-Induced Toxic Epidermal Necrolysis

Medical Faculty, Department of Dermatology, Celal Bayar University, Manisa, Turkey

Serap Ozturkcan, MD

Medical Faculty, Department of Dermatology, Celal Bayar University

Isil Inanir, MD

Medical Faculty, Department of Dermatology, Celal Bayar University

Elif E Filiz, MD

Medical Faculty, Department of Dermatology, Celal Bayar University

Reprints: Dr. Sahin, Mansuroglu Mahallesi, 273/1 Sokak, Cemre Apt. A-Blok, No: 36/3-3, 35030 Bornova, Izmir, Turkey, fax 90 236 2370213, mustafaturhan{at}superonline.com

OBJECTIVE: To report a case of toxic epidermal necrolysis (TEN) in a man who was treated with oral norfloxacin for prostatitis.

CASE SUMMARY: A 40-year-old man presented with a severe skin reaction, which was diagnosed as TEN. He had received norfloxacin 800 mg/day over a 14-day period for prostatitis and, 10 days after finishing the treatment regimen, he developed cutaneous and mucous lesions typical of TEN. After a prolonged hospitalization and treatment with oral prednisolone therapy, fluid resuscitation, and wound dressing, the man recovered.

DISCUSSION: TEN is an infrequent, yet often fatal, severe systemic and cutaneous disease that is most often an adverse drug reaction. There are few case reports of TEN induced by fluoroquinolones. A MEDLINE search (1966–February 2005) revealed no reports of toxic epidermal necrolysis, but one incidence of Stevens–Johnson syndrome due to norfloxacin therapy. An objective causality assessment suggests that TEN was probably related to norfloxacin in this patient.

CONCLUSIONS: To our knowledge, this is the first case of TEN associated with the use of oral norfloxacin. We hope that this case report creates awareness that norfloxacin-induced TEN is possible.

Key Words: norfloxacin, Stevens–Johnson syndrome, toxic epidermal necrolysis

Published Online, February 15, 2005. www.theannals.com, DOI 10.1345/aph.1E530