Severe cutaneous adverse reaction to amoxicillin-clavulanate: Pediatric toxic epidermal necrolysis in the Gulf: A case report and literature review.

INTRODUCTION AND

IMPORTANCE

Toxic epidermal necrolysis (TEN) is a severe form of Stevens-Johnson syndrome (SJS), and both are rare blistering skin reactions triggered by drugs and illnesses.

CASE PRESENTATION: We have reported a case of a previously healthy five-year-old boy who presented with a maculopapular rash covering more than 90 % of the total body surface area (TBSA), bilateral conjunctivitis, and oral thrush five days after receiving amoxicillin-clavulanate for upper respiratory infection. On assessment, dehydrated, hemodynamically unstable with extensive, dark maculopapular rash covering approximately 90 % of the total body surface area, skin biopsy confirmed full-thickness epidermal necrosis with lymphocytic dermal infiltration consistent with TEN. The patient was managed in the pediatric intensive care unit with rehydration, immediate cessation of the culprit drugs, surgical debridement, and aggressive wound care, as well as Intravenous immunoglobulin, systemic steroids, and meropenem for sepsis prophylaxis. Despite the patient developing complications (respiratory distress syndrome necessitating 9-day mechanical ventilation), the reepithelialization began by day ten, and the patient was extubated after 80 % wound healing.

CLINICAL DISCUSSION: This case discusses Toxic epidermal necrolysis (TEN), a rare and severe skin response caused by amoxicillin-clavulanate exposure in a pediatric patient. Early clinical diagnosis confirmed by skin biopsy and immediate management with supportive care, corticosteroids, and intensive wound care contributed to full recovery despite involvement of more than 90 % of the body.

CONCLUSION

Though TEN remains a medical emergency, even in severe cases, the timely and multidisciplinary approach can have a good outcome. It is a clinical reminder for clinicians to maintain a high index of suspicion of drug-induced severe cutaneous reactions, especially in children.