Toxic epidermal necrolysis associated with phenytoin in a 6-year-old child: a case report

Toxic epidermal necrolysis (TEN) is a severe mucocutaneous syndrome often triggered by adverse drug reactions, characterized by extensive skin detachment. We present a rare case of a 6-year-old boy developing TEN associated with phenytoin use for post-bacterial meningitis seizures. The patient initially presented with fever, epigastric pain, oral ulcers, and skin rashes, later progressing to extensive skin peeling. Phenytoin was promptly discontinued. The SCORTEN score indicated a mortality rate of 35.3%. Informed consent was taken by parents. The patient received supportive care, including IV fluids, antibiotics, and topical treatments. The patient exhibited a positive response to early initiation of systemic steroids (Dexamethasone) and cyclosporine, leading to a successful recovery within 15 days. This case underscores the importance of recognizing and managing drug induced TEN promptly, especially in pediatric populations, and highlights potential immunopathologic pathways and genetic predispositions to the condition.