Gabapentin-induced toxic epidermal necrolysis in a diabetic hypertensive patient: A rare case report

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BSTRACT

Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous reaction, usually drug-induced, with significant morbidity and mortality. A 65-year-old woman presented with fever, painful oral ulcers, conjunctival redness, dysphagia, and rapidly progressive widespread skin lesions following initiation of gabapentin. Clinical examination revealed > 80% body surface area epidermal detachment with mucosal involvement. A positive pseudo-Nikolsky sign and skin biopsy showing full-thickness epidermal necrosis confirmed TEN. The SCORTEN score was 3, indicating a moderate risk of mortality. Gabapentin was immediately discontinued, and the patient was managed with systemic corticosteroids, broad-spectrum antibiotics, fluid and electrolyte balance, nutritional support, and multidisciplinary care in the intensive care unit. Re-epithelialization occurred, and the patient was discharged after 22 days with residual pigmentary changes but no major sequelae. Early recognition, prompt withdrawal of the offending drug, and intensive supportive care are crucial in improving outcomes.