ArticleFrontiers in toxicology2026
Toxic epidermal necrolysis and acute kidney injury following co-trimoxazole rechallenge and voriconazole accumulation as an exacerbating cofactor: a case report.
Article in Frontiers in toxicology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Toxic epidermal necrolysis (TEN) is a life-threatening severe cutaneous adverse drug reaction with high mortality. Acute kidney injury (AKI) is a common complication of TEN, significantly increasing mortality risk. Immunocompromised patients frequently require combination therapy with voriconazole and co-trimoxazole for concurrent infections, which may lead to complex toxicities. Case Presentation: A 60-year-old male with nephrotic syndrome on long-term corticosteroids was diagnosed with Conclusion: Co-trimoxazole rechallenge strongly supports a causal link to TEN. AKI pathogenesis was multifactorial: primarily driven by TEN-associated systemic inflammation, with voriconazole accumulation due to CYP2C19 intermediate metabolism and drug interaction serving as a likely exacerbating co-factor. This case underscores the importance of therapeutic drug monitoring, pharmacogenetic testing, and integrated cross-organ surveillance when using high-risk antimicrobial combinations.
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