Roberts Hugh, Chamberlain Alexander, Rennick Gordon, McLean Catriona, Gin Douglas
Department of Dermatology, Alfred Hospital, Prahan, Victoria, Australia.
Australas J Dermatol. 2006 May;47(2):114-6. doi: 10.1111/j.1440-0960.2006.00243.x.
A 48-year-old man presented with a maculopapular truncal rash 9 days following intravenous amphetamine use. He subsequently developed widespread bullae over his trunk and upper limbs. Treatment was initially commenced with intravenous hydrocortisone. A diagnosis of toxic epidermal necrolysis was made and the treatment was changed to intravenous immunoglobulin at a lower dose than requested. At the height of the reaction, there was 90% body surface area involvement with tri-mucosal involvement. His response to the intravenous immunoglobulin was poor and was complicated by infection with methicillin-resistant Staphylococcus aureus, Candida albicans and Pseudomonas aeruginosa. Gradual re-epithelialization took place over the next 6 weeks.
