Roxithromycin-Induced Toxic Epidermal Necrolysis

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.'