This case report highlights a very rare
adverse drug reaction of oral
roxithromycin causing
toxic epidermal necrolysis (TEN). A 54-year-old male patient diagnosed with
upper respiratory tract infection was prescribed oral
roxithromycin 150 mg twice daily for 7 days. On the 10th day, the patient was admitted to the emergency with
sore throat, redness, watering of eyes, painful micturition, and severe skin lesions. The skin lesions were multiple, severely painful, burning, coalesced, and filled with fluid-producing large
blisters appearing on the lip, face, and trunk and then gradually spreading to legs, arms, palms, hands, and feet extensively involving much >30% of body surface area. Clinical examination, blood investigation, and histopathological examination of the skin confirmed the diagnosis of TEN. There was no history of any concomitant medications,
drug allergy,
burn injury, recent graft, or transplant or any coexisting
infections such as
herpes simplex. Other resembling
skin diseases were eliminated after proper dermatological examination. This episode of TEN was probably
drug (
roxithromycin) induced. The
drug was immediately stopped, and the patient was treated meticulously resulting in gradual reversal of the diseased state. Naranjo
adverse drug reaction probability scale suggested the likelihood that
oral administration of
roxithromycin was responsible for the TEN was 'probable.'