Cefuroxime-induced toxic epidermal necrolysis in a 4-year-old male child: a case report.

Introduction: Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous reaction characterized by extensive epidermal detachment and multi-organ involvement. It is most commonly triggered by drugs, including antibiotics such as cephalosporins. Although TEN predominantly affects adults and females, its occurrence in pediatric males is exceedingly rare. Here, we report a fatal case of cefuroxime-induced TEN in a 4-year-old child, emphasizing the importance of early diagnosis, appropriate drug withdrawal, and timely intervention. Case presentation: A 4-year-old Pakistani boy presented with persistent high-grade fever, widespread skin desquamation, and mucosal involvement. One month prior, he was prescribed cefuroxime for suspected measles. Within days of initiating therapy, he developed progressive epidermal detachment (>30% of total body surface area), confirming TEN. Laboratory findings revealed anemia, thrombocytopenia, elevated liver enzymes, and markers of systemic inflammation. Despite immediate drug cessation and supportive management, including intravenous fluids, wound care, and mechanical ventilation, his condition deteriorated, leading to multi-organ failure and death. Discussion: Cephalosporin-induced TEN is exceptionally rare, particularly in pediatric patients. The pathogenesis involves oxidative stress and keratinocyte apoptosis mediated by TNF-alpha. Treatment primarily consists of supportive care, with emerging therapies such as intravenous immunoglobulin and TNF-alpha inhibitors showing promise. However, limited healthcare resources often hinder access to these interventions in low-income settings. Conclusion: This case highlights the fatal potential of TEN, particularly when access to specialized care is limited. Early drug withdrawal and aggressive supportive care remain crucial for improving survival outcomes. Rational antibiotic prescribing is essential to prevent such adverse drug reactions.