{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:10:18Z","timestamp":1756361418055,"version":"3.44.0"},"reference-count":14,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,10,8]]},"published-print":{"date-parts":[[2020,10]]},"abstract":"<jats:p>Toxic epidermolysis necrosis (TEN) or Lyell syndrome is a potentially life-threatening immunological adverse skin disease, which mostly occurs secondary to the intake of an offending drug. It commonly manifests as a widespread exfoliating bullous lesion in skin and mucous membrane mimicking superficial burns and may result in hypovolemic and\/or septic shock. Authors report an unusual case of Lyell\u2019s syndrome in a 42-year-old woman, secondary to the intake of Ayurveda medicine \u2018Vajra Bhasma\u2019 (Diamond Ash) prescribed by an Ayurveda physician for treatment of her trigeminal neuralgia. After 8th day of continuous medication intake, she had prodromal illness and rapidly developing exfoliative skin lesion extended over 80% of total body surface area, breathing difficulty, dizziness and anuria. The case was successfully managed by timely diagnosis, adequate hydration and administration of immunoglobulins. After 17\u2009days, the skin epithelium regenerated, and she improved clinically with some depigmented lesions at discharge, which were normalised without any sequel during her further follow-up visits in hospital. Identification and withdrawal of the suspected drug, adequate resuscitation and early immunoglobulin administration are critical in management of TEN.<\/jats:p>","DOI":"10.1136\/bcr-2020-237891","type":"journal-article","created":{"date-parts":[[2020,10,30]],"date-time":"2020-10-30T17:11:37Z","timestamp":1604077897000},"page":"e237891","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Vajra Bhasma, Ayurvedic medicine: a rare and unusual cause of Lyell\u2019s syndrome and its successful management"],"prefix":"10.1136","volume":"13","author":[{"given":"Shivakumar M","family":"Channabasappa","sequence":"first","affiliation":[{"name":"Anaesthesiology, Subbaiah Institute of Medical Science, Shimoga, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3108-0408","authenticated-orcid":false,"given":"Bhavna","family":"Gupta","sequence":"additional","affiliation":[{"name":"Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, Uttrakhand, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shruthi","family":"Dharmappa","sequence":"additional","affiliation":[{"name":"Department of Oral Pathology and Microbiology, Subbaiah Institute of Dental Sciences, Shimoga, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,10,30]]},"reference":[{"key":"2025082722322354000_13.10.e237891.1","doi-asserted-by":"publisher","DOI":"10.2165\/00128071-200001060-00003"},{"key":"2025082722322354000_13.10.e237891.2","doi-asserted-by":"publisher","DOI":"10.1016\/0895-4356(96)00035-2"},{"key":"2025082722322354000_13.10.e237891.3","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e31821201ed"},{"key":"2025082722322354000_13.10.e237891.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199411103311906"},{"key":"2025082722322354000_13.10.e237891.5","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1990.01670250043005"},{"key":"2025082722322354000_13.10.e237891.6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199512143332404"},{"key":"2025082722322354000_13.10.e237891.7","doi-asserted-by":"crossref","first-page":"481","DOI":"10.5021\/ad.2018.30.4.481","article-title":"A case of Stevens-Johnson syndrome probably induced by herbal medicine","volume":"30","author":"Lim","year":"2018","journal-title":"Ann Dermatol"},{"key":"2025082722322354000_13.10.e237891.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-0960.2011.00862.x"},{"key":"2025082722322354000_13.10.e237891.9","doi-asserted-by":"publisher","DOI":"10.12788\/j.sder.0058"},{"key":"2025082722322354000_13.10.e237891.10","doi-asserted-by":"publisher","DOI":"10.1038\/jid.2012.510"},{"key":"2025082722322354000_13.10.e237891.11","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-230538","article-title":"Stevens-Johnson syndrome\/toxic epidermal necrolysis: treatment with low-dose corticosteroids, vitamin C and thiamine","volume":"12","author":"Middendorf","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2025082722322354000_13.10.e237891.12","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1016\/j.burns.2014.01.027","article-title":"Effect of N-acetylcysteine combined with infliximab on toxic epidermal necrolysis. A proof-of-concept study","volume":"40","author":"Paquet","year":"2014","journal-title":"Burns"},{"key":"2025082722322354000_13.10.e237891.13","doi-asserted-by":"crossref","first-page":"941","DOI":"10.1016\/j.jaad.2014.07.016","article-title":"Retrospective review of Stevens-Johnson syndrome\/toxic epidermal necrolysis treatment comparing intravenous immunoglobulin with cyclosporine","volume":"71","author":"Kirchhof","year":"2014","journal-title":"J Am Acad Dermatol"},{"key":"2025082722322354000_13.10.e237891.14","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1747.2000.00061.x"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2020-237891","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T05:32:34Z","timestamp":1756359154000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2020-237891"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10]]},"references-count":14,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2020,10,30]]},"published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1136\/bcr-2020-237891"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2020-237891","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2020,10]]}}}