JRD Journal of Rheumatic Diseases J Rheum Dis 2093-940X 2233-4718 The Korean College of Rheumatology 10.4078/jrd.2013.20.6.374 jrd-20-374 Case Report Toxic Epidermal Necrolysis by Ceftriaxone in Patient with Newly Diagnosed Systemic Lupus Erythematosus LeeJae Ho JuIl Nam ChoHyung Jun MinHong Ki HongYeon-Sik Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon, Korea Corresponding Yeon-Sik Hong, Division of Rheumatology, Department of Internal Medicine, School of Medicine, The Catholic University of Korea, Incheon St. Mary's Hospital, 56, Dongsuro, Bupyeong-gu, Incheon 403-720, Korea. E-mail : rhcow1@yahoo.co.kr 12 2013 31 12 2013 20 6 374 377 26092012 10012013 10012013 Copyright © 2013 The Korean College of Rheumatology 2013 This is a Free Access article, which permits unrestricted non-commerical use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract

Toxic epidermal necrolysis (TEN) is a rare disease in abso-lute numbers with an incidence of 2 cases per million peo-ple per year. Most cases of TEN are caused by drugs, but certain infectious diseases may have an impact on the risk. There are rare reports of TEN occurring without history of drug ingestion in systemic lupus erythematosus (SLE), appearing similar to cutaneous lupus and early TEN manifestations, such as erythema multiforme. This report de-scribes a patient with SLE who presented with manifestations of TEN after ceftriaxone treatment. The patient was newly diagnosed with SLE and TEN occurring eight days after cessation of ceftriaxone. Considering possible etiol-ogies, we could not exclude ceftriaxone as the cause of TEN. After intravenous immunoglobulin with glucocorticoid, clinical symptoms improved.

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It shows blistered skin lesions in back (A) and upper abdomen (B).

It shows skin detachment and new epidermis regeneration. Skin detachment start in back at hospital day 22 (A). Around hospital day 30, almost skin detachment is over and new epidermis go into new regeneration (B).

It shows skin pathology stained haematoxylin eosin. Epidermis separate from subepidermal layer (A, ×100). Several vacuo-lization were observed in subepidermal layer (B, ×400). Because total seperat-ion from dermal- epidermal junction, it is difficult to observe the vacuolar alteration and solitary necrotic kerati-nocyte. How-ever, it is not observed that moderate to dense periadnexal and perivascular lymphocyte infiltration consistent with SLE.