Case of toxic epidermal necrolysis after prescription of methampyrone for tooth ache.
This article describes the case of a 58-year-old male patient with methampyrone-induced toxic epidermal necrolysis. The patient presented with severe itching and flaking of the entire body. The patient’s history revealed that he had previously consulted a private physician for a tooth ache, for which the doctor prescribed him methampyrone 500 mg orally. The patient developed a maculopapular and erythematous rash after taking a single dose of the medication. This was followed by itching and bullous exfoliation of the skin. The findings were consistent with the diagnosis of methampyrone-induced necrolysis.
The patient’s medical history was significant for hypertension and postprimary coronary intervention. He was currently taking aspirin, amlodipine and atorvastatin. Examination showed that the patient was conscious and alert, however, he looked weak. Similarly, his hemodynamics were stable. Conjunctivitis and turbid corneal was notable in both the eyes with ulceration around the mouth and swollen lips. He was also suffering from generalised skin erythema and itchy purpuric macules that were irregularly shaped. Nikolsky’s sign was positive with a clear detachment of the epidermis when rubbed slightly.
The epidermal detachment was evident in 30% of the body surface area.
Doctors managed the patient with replacement of fluid, electrolyte imbalance maintenance and antibiotic therapy. He was also started on methylprednisolone and cyclosporin. However, the patient’s skin did not show any improvement. The skin change progression went from 32% to 62% with grade I and grade II hemorrhagic blisters.
Based on clinical judgement and the patient’s condition, doctors decided to treat the patient with therapeutic plasma exchange (TPE). The procedure was started on the 3rd day of admission, with a total of 3 procedures provided every 2 days. After completion of the first session of TPE, the patient’s condition improved rapidly. The blistering and epidermal necrosis started showing improvement after the second and third dose of TPE. One week after TPE, rapid reepithelization occurred. The patient made an uneventful recovery and was discharged on the 8th day of admission. Moreover, the lesions had completely disappeared at follow-up.
References
Successful Treatment of Methampyrone-Induced Toxic Epidermal Necrolysis with Therapeutic Plasma Exchange https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6079558/
