case_images: PMC10461315_01
case_images: Timeline of the three known events with a detailed medication history of the last 4 weeks before the onset of the severe skin reaction on 9 July 2017. The black bars represent the daily intake of a drug, and the gray bars represent an intermittent or unknown intake. GBFDE, generalized bullous fixed drug eruption; EN, epidermal necrolysis.
case_images: fmed-10-1125754-g0001.jpg
case_images: PMC10461315_01_fmed-10-1125754-g0001.jpg
case_images: F1
case_images: The consultant dermatologist made a diagnosis of recurrent EN of unknown origin due to taking multiple medications (Figure 1) and took a biopsy. The patient reported that he had not taken acetaminophen (paracetamol) this time but other pain medications (Figure 1).
case_images: Evolution of the severe skin reaction on the back and buttocks. (A) Extensive epidermal detachment: large areas of detachable skin without marked erythema or exanthema (10 July 2017); (B) healing phase: almost the entire back and buttocks are detached (19 July 2017), (C) the previously affected sites heal, leaving well-demarcated residual hyperpigmentation (31 July 2017), and (D) epidermal detachment: areas of detachable skin to a lesser extent (3 August 2017) compared to the reaction 1 month before.
case_images: fmed-10-1125754-g0002.jpg
case_images: PMC10461315_01_fmed-10-1125754-g0002.jpg
case_images: F2
case_images: Despite the initiated therapy, the blisters increased within the next few days resulting in large detached areas of the BSA (more than 30%), and the patient was transferred to a burn unit (Figure 2A). Within the next few days, the progression stopped and re-epithelialization started (Figure 2B), the patient did no longer require catecholamines, and the topical treatment was modified. During the process of wound healing, the pattern became more suggestive for GBFDE because there were clearly demarcated, large brownish patches (Figure 2C). The symptoms aggravated overnight, and consecutively, the patient was again transferred to the burn unit (Figure 2D).