Introduction: Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS-TEN) is a rare, immune-mediated skin emergency, often drug-induced. Diagnosis and management become more complex in immunocompromised patients with multiorgan failure or oncologic comorbidities. Description: A 72-year-old man with newly diagnosed angioimmunoblastic T-cell lymphoma developed fever, rash, and hypotension one week after completing a 10-day course of oral levofloxacin for a groin seroma at the site of a prior lymph node biopsy. He was admitted to the ICU for hemodynamic instability requiring vasopressors and intravenous hydrocortisone. A diffuse morbilliform rash rapidly progressed to bullae and epidermal sloughing (>30% BSA), with a positive Nikolsky sign. Biopsy confirmed SJS-TEN overlap. RegiSCAR score was 4/7 (age >40, malignancy, tachycardia, serum urea >10 mmol/L), consistent with 60% predicted mortality. High-dose methylprednisolone and IVIG were initiated, but IVIG was discontinued after 2 doses due to worsening renal function (creatinine rose from 2.3 to 5.4 mg/dL). Tumor lysis syndrome (TLS) developed secondary to steroids (uric acid >9 mg/dL), managed with rasburicase. His course was complicated by CMV colitis, GI bleeding, and rising transfusion needs. After multidisciplinary discussion, he was not considered a candidate for chemotherapy or burn center transfer. The patient transitioned to inpatient hospice. Discussion: This case highlights the diagnostic and therapeutic complexity of SJS-TEN in oncologic ICU patients. Levofloxacin is a recognized trigger of TEN, though rarely reported. SCORTEN remains a validated prognostic tool and supported early ICU escalation. Standard therapies—high-dose corticosteroids and IVIG—must be weighed against complications like TLS and renal failure, especially in patients with malignancy. Transfer to burn centers may not be possible when BSA slough is limited (< 10%) or overall prognosis is poor. ICU teams should maintain a high index of suspicion for drug-induced SJS-TEN, balance immunosuppression with renal risk, and involve palliative services early in multisystem disease.
Abid et al. (2026) studied this question.