Toxic Epidermal Necrolysis in an HIV-Infected Patient.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but potentially fatal cutaneous adverse drug reactions, mediated by type IV hypersensitivity mechanisms triggered by medications such as antibiotics, antiepileptics, allopurinol, and non-steroidal anti-inflammatory drugs (NSAIDs). Various risk factors, including human immunodeficiency virus (HIV) infection, increase susceptibility to these severe reactions. Early symptoms are often non-specific and may precede the characteristic skin and mucosal lesions. Diagnosis requires thorough clinical and laboratory evaluation, including causality assessment tools such as the Algorithm for Drug Causality in Epidermal Necrolysis (ALDEN). Management demands a multidisciplinary approach focusing on supportive care and infection prevention, with emerging evidence supporting immunomodulatory therapies like cyclosporine and combined intravenous immunoglobulin and corticosteroids. This case report describes a 36-year-old HIV-positive man who developed carbamazepine-induced TEN. The diagnosis of TEN was confirmed clinically and supported by a positive causality assessment using the ALDEN. The patient was managed with supportive care and immunomodulatory treatment with cyclosporine and systemic corticosteroids, leading to gradual re-epithelialization and clinical improvement. This case highlights the increased risk of severe cutaneous adverse reactions in HIV-positive patients. Early recognition and multidisciplinary management are essential for improved outcomes.