Drug-Induced Toxic Epidermal Necrolysis with Rare Pneumomediastinum in Children: A Case Report

Abstract

Background:Toxic Epidermal Necrolysis (TEN) is a life-threatening dermatologic emergency. While primarily a cutaneous disease, severe cases may involve the respiratory epithelium, leading to rare complications such as pneumomediastinum and subcutaneous emphysema, which signify a poor prognosis. Pneumomediastinum complicating pediatric TEN is exceptionally rarely reported, giving this case notable educational and clinical value. This case report describes the clinical approach and successful multidisciplinary management of a pediatric patient with drug-induced TEN complicated by rare air-leak syndromes and sepsis.Case Report: A 9-year-old boy presented with widespread blistering and epidermal detachment involving more than 30% of the total body surface area (TBSA) following amoxicillin administration (ALDEN score +2, possible). The condition rapidly progressed to TEN with extensive mucosal involvement and a SCORTEN of 2 (predicted mortality 12.1%) was determined on admission. Patient’s condition in Pediatric Intensive Care Unit (PICU) was complicated by sepsis, bilateral pneumonia, pneumomediastinum, and subcutaneous emphysema. Because of clinical deterioration under first-line corticosteroids, immunomodulatory therapy was escalated in a stepwise manner within a multidisciplinary intensive care setting. Significant clinical improvement followed, characterized by complete cessation of new lesion formation, progressive re-epithelialization, and radiological resolution of the pneumomediastinum. The patient was discharged after 17 days with near-complete skin healing and resolved systemic complications. Conclusion: Pediatric TEN complicated by pneumomediastinum and sepsis requires careful, multidisciplinary intensive care with early recognition of respiratory deterioration and prompt escalation of immunomodulatory therapy. In selected severe pediatric TEN cases, this approach may contribute to favorable clinical outcomes.