key: cord-0706772-ab85thlg
authors: O'Brien, Kathleen F.; Maiman, Rachel E.; Marathe, Kalyani
title: Idiopathic toxic epidermal necrolysis in an adolescent
date: 2019-03-31
journal: Pediatr Dermatol
DOI: 10.1111/pde.13820
sha: a03c21659e8036bf826d23fd3caebfa65fb34c61
doc_id: 706772
cord_uid: ab85thlg

A 10‐year‐old girl, suspected 2 days prior to have streptococcal pharyngitis, presented with diffuse erythema, tense bullae, Nikolsky‐positive desquamation, as well as ulcerations of her oral and genital mucosa. She denied recent travel, sick contacts, or preceding and concurrent use of medications, including over‐the‐counter and herbal supplements. A comprehensive viral polymerase chain reaction (PCR) panel, Mycoplasma pneumoniae PCR and IgM, streptococcal molecular antigen test, urine culture, blood culture, and rheumatologic serologies were negative. Based on the patient's clinical presentation and biopsy results, she was diagnosed with idiopathic toxic epidermal necrolysis.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are severe and potentially fatal mucocutaneous diseases. 1 In the United States, the estimated incidence of TEN among children is 0.4/1 000 000 per year. 2, 3 Medications and infectious agents are the most common reported causes. We report a challenging diagnosis of TEN with uncertain etiology in a pediatric patient.

A 10-year-old girl initially presented with acute onset of throat pain, fever, rash, and erythematous tonsils with white exudate. She denied the use of any medications, including over-the-counter and herbal supplements. There was no history of medication allergies, recent travel, sick contacts, or preceding illness. Oropharyngeal rapid group A streptococcus antigen test was negative, and she was discharged on an empiric course of amoxicillin; however, the prescription was never filled.

Two days later, she returned febrile and tachycardic. She had diffuse erythema, tense bullae, and Nikolsky-positive desquamation covering 80% of her body surface area, as well as severe oral and vaginal mucositis ( Figure 1 ). C-reactive protein was elevated (22.64 mg/dL, normal <3 mg/dL), and a chest radiograph was consistent with interstitial pneumonia. The remainder of her labora- 

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