Fatal toxic epidermal necrolysis associated with hydroxychloroquine

Extract

Sir, We report a fatal case of toxic epidermal necrolysis (TEN) associated with hydroxychloroquine. A 39‐year‐old woman gave a 5‐year history of sero‐positive nodular rheumatoid disease, lymphopenia and a positive ribonucleoprotein antibody. For 4 years she had unexplained hepatitic liver biochemistry with a fatty liver on ultrasound. Renal function was normal and other autoantibodies were negative.

She was given hydroxychloroquine 200 mg twice daily for peripheral painful synovitis. She had previously proved intolerant of other second‐line agents, including a psorisiform rash with gold. The patient volunteered no other history of skin disease. Inadvertently she took twice the prescribed dose of hydroxychloroquine. She discontinued the drug after 2 weeks due to nausea. A day later blotchy erythema was noted on her neck, which then extended to other areas of the body. For more than 3 months her other medication had been Gaviscon 10 mL when required, Co‐dydramol two tablets four times per day and meloxicam 7.5 mg daily. She had taken Co‐dydramol and meloxicam every day for joint pain.