{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T15:29:05Z","timestamp":1788276545313,"version":"build-2803163510"},"reference-count":20,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T00:00:00Z","timestamp":1778457600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Cutan Pathol"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Toxic epidermal necrolysis (TEN) is a life\u2010threatening mucocutaneous reaction characterized by rapidly progressive epidermal necrosis within hours to days, extensive skin detachment, and high mortality. Rarely, patients present with TEN\u2010like eruptions that evolve slowly, over days to weeks, and have skin changes mostly confined to photodistributed areas, with possible mucosal involvement. The latter scenario is compatible with TEN\u2010like lupus erythematosus. We report a 65\u2010year\u2010old man without prior lupus history who developed a widespread, photodistributed erythematous patchy eruption within 24\u2009h of initiating donepezil for Parkinsonism\u2010associated aphasia. The erythema rapidly progressed to erosions, bullae, and detachment involving 81% total body surface area (TBSA) and a Severity\u2010of\u2010Illness Score for Toxic Epidermal Necrolysis (SCORTEN) of 2. Initial differential diagnoses included TEN\/Stevens Johnson Syndrome (SJS), bullous pemphigoid, generalized bullous fixed drug eruption, Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), and reactive infectious mucocutaneous eruption (RIME). Histopathology revealed interface dermatitis with diffuse basilar apoptosis, focal full\u2010thickness epidermal necrosis and robust dermal mucin deposits. Direct immunofluorescence study was negative. Serologies showed strongly positive anti\u2010Ro\/SSA and ANA titers. COVID\u201019 testing was positive. The constellation of clinical, pathologic and laboratory features supported a diagnosis of TEN\u2010like subcutaneous lupus erythematosus (SCLE), likely triggered by donepezil and complicated by a concurrent COVID\u201019 infection. To our knowledge, this is a novel case of TEN\u2010like SCLE associated with donepezil initiation.<\/jats:p>","DOI":"10.1111\/cup.70109","type":"journal-article","created":{"date-parts":[[2026,5,12]],"date-time":"2026-05-12T02:13:27Z","timestamp":1778552007000},"page":"946-954","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rare Presentation of\n                    <scp>TEN<\/scp>\n                    \u2010Like Subacute Cutaneous Lupus Erythematosus Occurring in the Setting of Donepezil Exposure and\n                    <scp>COVID<\/scp>\n                    \u201019 Infection: A Diagnostic Challenge"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7021-7290","authenticated-orcid":false,"given":"Sydney","family":"Kenney","sequence":"first","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine  Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Acosta","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine  Pasadena California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Castillo","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, Department of Dermatology Kaiser Permanente School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Cassarino","sequence":"additional","affiliation":[{"name":"Department of Pathology Kaiser Permanente School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aparche","family":"Yang","sequence":"additional","affiliation":[{"name":"Southern California Permanente Medical Group, Department of Dermatology Kaiser Permanente School of Medicine  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1067\/mjd.2003.107"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.81798"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jdcr.2022.09.009"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1177\/0961203313492242"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afv123"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ced.14648"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555\u20100785"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/09612033251371801"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-74698-2_195-1"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.5114\/ada.2021.112281"},{"issue":"1","key":"e_1_2_10_12_1","first-page":"6","article-title":"Histopathological and Epidemiological Characteristics of Patients With Erythema Exudativum Multiforme Major, Stevens\u2010Johnson Syndrome and Toxic Epidermal Necrolysis","volume":"135","author":"Rzany B.","year":"1996","journal-title":"British Journal of Dermatology"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15558"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mehy.2020.110033"},{"key":"e_1_2_10_15_1","volume-title":"Weedon's Skin Pathology","author":"Patterson J. 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