A 66-year-old woman with toxic epidermal necrolysis and a fatal course

A 66-year-old woman was admitted to a hospital burn unit with a peeling rash over 85% of her body. She had a history of chronic kidney failure and arthritis, for which she took corticosteroids. Six weeks before admission, she had started methotrexate for her arthritis. Three weeks later she developed ulcers in her mouth and throat and was admitted to a hospital. She developed skin lesions on her back, which spread to the rest of her body except her legs, and eventually the skin began to peel away. She was given antibiotics and transferred to a burn unit. Blood cultures revealed infection with Klebsiella pneumoniae. CT scans showed lung and brain abnormalities. She died 27 days after admission to the burn unit. At autopsy, her skin had peeled away over 90% of her body. Examination of lung and brain tissue revealed extensive fungal infection with Aspergillus fumigatus. The destruction of her outer skin layer was probably caused by one of the drugs she was taking.