Levamisole induced toxic epidermal necrolysis in a patient with nephrotic syndrome: A case report

Abstract

INTRODUCTION: Toxic epidermal necrolysis (TEN) is an uncommon, potentially life-threatening muco-cutaneous condition, which may occur as an adverse reaction (Type IV hypersensitivity) to a number of drugs. It is characterized by variable degrees of epidermal necrosis and detachment leading to increase morbidity and mortality. We describe the case of a patient with nephrotic syndrome who developed TEN, presumably induced by Levamisole. To our knowledge, this is the first report of TEN arising during levamisole treatment. CASE REPORT: A 11 year old girl, who has steroid dependent nephrotic syndrome, was started on levamisole. She developed skin and mucosal lesions suggestive of TEN 3 weeks after taking levamisole. The diagnosis of TEN in our patient was made clinically and confirmed histologically. Based on the temporal relationship of levamisole therapy and the development of her adverse cutaneous reaction, we concluded that levamisole was the offending agent. CONCLUSION: We report this case to increase awareness of this potential life-threatening complication of levamisole.