Toxic Epidermal Necrolysis Associated with Tetracycline Eye Ointment: A Case Report

Abstract

Toxic epidermal necrolysis (TEN) is a rare but potentially life threatening severe cutaneous adverse reaction with widespread epidermal detachment and mucosal erosions usually induced by medications. Tetracycline eye ointment is not known to cause TEN and recent literature search found no published articles that associate tetracycline (TTC) eye ointment and TEN. However, the Eritrean National Pharmacovigilance Centre has received one serious cutaneous reaction immediately following application of TTC eye ointment. The aim of this case report is therefore to describe this unusual and interesting adverse drug reaction, it’s possible explanations and treatment outcomes of the event. This is a case of 15 years old female patient admitted to hospital with a presentation of body skin desquamation, fever and malaise, eye and mouth pain with redness. Notably, this case study is designed for the peculiarity of its occurrence with a single dose instillation of tetracycline eye ointment purchased as an over the counter drug. As a result, patient developed generalized skin lesion with about 80% skin involvement. Though TEN is usually drug induced, it can also be explained with some etiological factors which can induce similar reaction such as infections as well as malignancy. Clinical and laboratory investigation report however show that the patient had no prior history of infection, history of allergy and other drugs intake. Taking into account the above facts complemented with the low disease background incidence, possible biological mechanism and the plausible time to reaction onset (4 days), this case is possibly associated with TTC eye ointment. The availability of tetracycline eye ointment without prescription in Eritrea makes this association alarming as it can amplify the occurrence of TEN. Hence, further studies are required to substantiate the association.