Ciprofloxacin‐Induced Near‐Total Toxic Epidermal Necrolysis Complicated by Upper Gastrointestinal Bleeding: A Case Report With ALDEN‐Based Causality Assessment

Toxic epidermal necrolysis (TEN) is a rare but life‐threatening mucocutaneous adverse drug reaction characterized by widespread epidermal necrosis and detachment with significant mucosal involvement. We report a case of near total (80%–90%) body surface area TEN in a previously healthy 30‐year‐old man that developed approximately 5 days after completing a 5‐day course of oral ciprofloxacin. The presentation was complicated by upper gastrointestinal bleeding with transient hemodynamic instability. Prompt withdrawal of the offending drug, aggressive supportive care in the intensive care unit, wound management, and multidisciplinary care led to successful recovery. Causality was assessed using the ALDEN (Algorithm of Drug Causality for Epidermal Necrolysis) score, which supported a probable association with ciprofloxacin. This case emphasizes the need for vigilance regarding fluoroquinolone‐associated severe cutaneous adverse reactions even after short‐term use, and the utility of structured causality assessment tools.