Toxic epidermal necrolysis (Lyell's syndrome) in a patient treated with amoxicillin with clavulanic acid

Toxic epidermal necrolysis (Lyell's syndrome) is a life-threatening toxic-allergic reaction with a high mortality rate. The relevance of the problem is due to the risk of developing this reaction to frequently prescribed antibacterial drugs in outpatient practice (in particular, inhibitor-protected penicillins), the complexity of diagnosis, as well as the lack of clinical guidelines approved by the Ministry of Health of the Russian Federation. The purpose of this study was to present a clinical case of toxic epidermal necrolysis associated with the use of amoxicillin+clavulanic acid and to draw attention to the issues of diagnosis and safety of antimicrobial therapy for community-acquired infections at the outpatient stage. Materials and methods. A 76-year-old patient with a history of hypertension, diabetes mellitus, and rectal cancer was prospectively observed for toxic epidermal necrolysis caused by amoxicillin+clavulanic acid, and his primary medical records. Research results. On the third day of taking amoxicillin+clavulanic acid for acute right-sided maxillary sinusitis, the patient developed toxic epidermal necrolysis with a high risk of mortality (≥ 90 % according to the SCORTEN scale). After discontinuation of the medication, hospitalization in a specialized department, and pathogenetic and symptomatic pharmacotherapy for the main and concomitant diseases, the patient showed a stable positive trend and complete regression of the skin lesions by the time of discharge from the hospital. Conclusions. The presented case confirms the need for a thorough collection of a pharmacological history and consultation with a clinical pharmacologist when patients present with any skin lesions associated with the use of medications. The approval of clinical guidelines for toxic epidermal necrolysis is a necessary measure for developing modern treatment and diagnostic strategies for managing patients with this adverse reaction, as well as for updating medical and economic standards for providing healthcare.

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