[SavageGlow]

An 18-year-old female patient presented to the emergency department of the Lebanese Hospital Geitaoui University Medical Center (LHG-UMC), Beirut, Lebanon, presenting with a diffuse mucocutaneous eruption that persisted for a duration of two weeks. The patient was previously healthy. Two weeks before the eruption, the patient was started on doxycycline 100 mg daily for the treatment of acne vulgaris. Following a two-week initiation of the medication, the patient reported experiencing a new onset of malaise, accompanied by a burning sensation in both her eyes and genital area. Additionally, she noted the emergence of a rash that began on her face and chest and rapidly spread to other areas of her body. The patient described the rash as pruritic. She denied taking illicit drugs, herbal supplements, or any over-the-counter medications besides doxycycline.

On admission, the patient was afebrile and tachycardic with a heart rate of 124 beats per minute, blood pressure of 104/69 mmHg, oxygen saturation of 99% on room air, and respiratory rate of 22 breaths per minute. On physical examination, the affected total body surface area was estimated at 80% with 12% skin detachment. She had diffuse tender dusky erythema with macules over the limbs, chest, neck, and back, and flaccid bullae over the neck, sparing the scalp. Nikolsky sign was positive. In addition, she had involvement of eyes, oronasopharyngeal, and anogenital mucosa .

Initial laboratory investigation revealed a hemoglobin of 12 g/dL (reference range of 12-16 g/dL), white blood cell counts of 8,050 (reference range of 4,800-10,800/mm3), C-reactive protein of 52 mg/L (reference range <6 mg/L), and a procalcitonin level of 0.06. Liver and kidney function tests were found to be within the reference range. A clinical diagnosis of TEN was made. Her severity of illness score for toxic epidermal necrolysis (SCORTEN), a prognostic score estimating the risk of death in the acute phase, was calculated at 2, placing our patient at a 12% mortality risk .

The patient was admitted to the burn center of the LHG-UMC, where she was isolated and received supportive care with fluid and electrolyte replenishment. Dressings were changed every 48 hours using only petroleum jelly and paraffin gauze. Doxycycline was withdrawn, and the patient was started on intravenous methylprednisolone 250 mg per day, clindamycin 600 mg every eight hours, and cyclosporine (3 mg/kg body weight per day). She also received eye drops of tobramycin and dexamethasone. Parenteral nutrition was started until oral mucosal lesions subsided. She had no pulmonary, gastrointestinal, or renal involvement. Biopsies taken on admission from her left arm and right thigh skin showed severe interface dermatitis with extensive keratinocyte necrosis, consistent with TEN .

Mucocutaneous lesions gradually improved , and her hospital stay was uneventful. After 20 days of hospitalization, she was discharged home. She was educated about the necessity of avoiding doxycycline and the risk of reexposure.

[Caveman5150]

I took that shit when I was a kid - it was awful. My lips would get so dry they cracked & bled if I so much as smiled... and I still had pimples

[Mr.NoCredit]

We need new science.

Why the fuck it’s still used as medication is beyond my comprehension.

I suppose they think 1 in 5000 it’s okay if that person dies. It still saves 4,999 other lucky people.

[HIGHTECHDUDE]

Well, it certainly distracted away from her pimples...

[wyldrozez]

The poor thing! My partner was on this medication for years. He told me the horror stories of how the pain made him almost untouchable. To this day he wishes that his family doctor never suggested it.

[Kaotic]

I'm allergic to that shit too. I took it once and within minutes my eyes started to swell shut and my throat began to swell. I drove straight to the ER and was injected with something to reverse it. They just gave me fluids and oxygen after that. Scared the shit out of me though