{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T21:21:03Z","timestamp":1778275263332,"version":"3.51.4"},"reference-count":12,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,3,31]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:p>Toxic epidermal necrolysis (TEN) is a rare, life-threatening dermatological emergency characterised by blistering and desquamation, often triggered by medications. Early identification and discontinuation of offending agents are critical for improving outcomes.<\/jats:p>\n                  <jats:p>Here, we describe a woman in her 30s with a complex medical history, including systemic lupus erythematosus and common variable immunodeficiency, who developed TEN following antifungal and antibacterial therapy. She initially presented with respiratory distress and was treated for pneumonia. Over the ensuing days, her clinical course rapidly deteriorated as she developed skin desquamation, tachycardia, hyperkalaemia and acute renal failure, and she was diagnosed with TEN. Suspected offending agents were discontinued, and treatment was initiated with intravenous immunoglobulin, corticosteroids and tumour necrosis factor-alpha blockade.<\/jats:p>\n                  <jats:p>This case illustrates the complexity of managing TEN in a patient with multiple comorbidities and ongoing immunosuppression, emphasising the importance of prompt recognition and treatment given the high mortality and morbidity of TEN.<\/jats:p>","DOI":"10.1136\/bcr-2025-269803","type":"journal-article","created":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T14:20:37Z","timestamp":1776694837000},"page":"e269803","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Antimicrobial toxic epidermal necrolysis in an ICU patient with multisystem organ failure and sepsis"],"prefix":"10.1136","volume":"19","author":[{"given":"Krystal","family":"Phu","sequence":"first","affiliation":[{"name":"School of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA"},{"name":"Department of Anesthesiology & Perioperative Medicine, Tufts Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine","family":"Li","sequence":"additional","affiliation":[{"name":"School of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Connor","family":"Pauplis","sequence":"additional","affiliation":[{"name":"School of Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA"},{"name":"Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehrak","family":"Moaddab","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology & Perioperative Medicine, UMass Chan Medical School, Worcester, Massachusetts, USA"},{"name":"Division of Critical Care Anesthesia, UMass Chan Medical School, Worcester, Massachusetts, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,4,20]]},"reference":[{"key":"2026042007200859000_19.4.e269803.1","doi-asserted-by":"crossref","unstructured":"Klimas N , Quintanilla-Dieck J , Vandergriff T . Stevens\u2013Johnson Syndrome and Toxic Epidermal Necrolysis. Cutaneous Drug Eruptions 2015;259\u201369. doi:10.1007\/978-1-4471-6729-7_24","DOI":"10.1007\/978-1-4471-6729-7_24"},{"key":"2026042007200859000_19.4.e269803.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jid.2017.01.031"},{"key":"2026042007200859000_19.4.e269803.3","doi-asserted-by":"crossref","first-page":"949520","DOI":"10.3389\/fmed.2022.949520","article-title":"Stevens-Johnson syndrome and toxic epidermal necrolysis: A systematic review of PubMed\/MEDLINE case reports from 1980 to 2020","volume":"9","author":"Wang","year":"2022","journal-title":"Front Med"},{"key":"2026042007200859000_19.4.e269803.4","doi-asserted-by":"crossref","unstructured":"Hidajat C , Loi D . Drug-mediated rash: erythema multiforme versus Stevens-Johnson syndrome. BMJ Case Rep 2014;2014. doi:10.1136\/bcr-2014-205543","DOI":"10.1136\/bcr-2014-205543"},{"key":"2026042007200859000_19.4.e269803.5","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1002\/cia2.12207","article-title":"Stevens\u2010Johnson syndrome\/toxic epidermal necrolysis\u2010like acute cutaneous lupus erythematosus in a patient with systemic lupus erythematosus","volume":"5","author":"Tanaka","year":"2022","journal-title":"J Cutaneous Imm & Allergy"},{"key":"2026042007200859000_19.4.e269803.6","doi-asserted-by":"publisher","DOI":"10.1038\/clpt.2009.252"},{"key":"2026042007200859000_19.4.e269803.7","doi-asserted-by":"publisher","DOI":"10.1007\/s40257-024-00889-6"},{"key":"2026042007200859000_19.4.e269803.8","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.136.3.323"},{"key":"2026042007200859000_19.4.e269803.9","doi-asserted-by":"publisher","DOI":"10.1046\/j.1523-1747.2000.00061.x"},{"key":"2026042007200859000_19.4.e269803.10","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1001\/jamadermatol.2018.5605","article-title":"Development and Validation of a Risk Prediction Model for In-Hospital Mortality Among Patients With Stevens-Johnson Syndrome\/Toxic Epidermal Necrolysis-ABCD-10","volume":"155","author":"Noe","year":"2019","journal-title":"JAMA Dermatol"},{"key":"2026042007200859000_19.4.e269803.11","doi-asserted-by":"crossref","unstructured":"Chang H-C , Wang T-J , Lin M-H , et al . A Review of the Systemic Treatment of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Biomedicines 2022;10. doi:10.3390\/biomedicines10092105","DOI":"10.3390\/biomedicines10092105"},{"key":"2026042007200859000_19.4.e269803.12","doi-asserted-by":"publisher","DOI":"10.1080\/09546634.2019.1577548"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269803","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T14:20:43Z","timestamp":1776694843000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269803"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4,20]]},"published-print":{"date-parts":[[2026,4]]}},"alternative-id":["10.1136\/bcr-2025-269803"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269803","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]}}}