A case report of paracetamol and diphenhydramine - induced toxic epidermal necrolysis


  • Pimhathai Wichaisuchart
  • Suttikiet Sampao
  • Sasithorn Mameechai
  • Mintra Tangrungruengkit


toxic epidermal necrolysis (TEN), paracetamol, acetaminophen, diphenhydramine


Toxic epidermal necrolysis are rare, acute and severe life-threatening allergic reactions.Initial symptoms (prodromal illness) can be fever, sore throat, malaise and any of which can precede cutaneous manifestations in 1-3 days. First, skin lesions tend to appear on the trunk, spread to the neck, face, upper and lower extremities. The skin lesion is erythematous, dusky red, purpuric macules of irregular size and shape, and they have a tendency to coalesce more than 30% body surface area. Presence of mucosal involvement more than one site and positive Nikolsky’s sign. Most common cause is medicine (80%). Other rare cause include infections and some immune diseases. Medication most frequently associated with TEN is allopurinol, lamotrigine, cotrimoxazole, carbamazepine, nevirapine, NSAIDs, phenobarbital and phenytoin. Hereby we report a 33 years old Thai male without medical problems presenting with malaise, fever, he had taken paracetamol and diphenhydramine from pharmacy store for 2 consecutive days. He had extensive rash on his body, eye irritation and oral ulcers. At the hospital, he still received paracetamol for fever but detachment of epidermis and erosion of mucocutaneous membrane continued. When he stopped taking paracetamol, his clinical
symptoms improved. Even both paracetamol and diphenhydramine have low incidence of severe adverse drug reaction, physical examination, biopsy test and other laboratory test didn’t show any causes. Drug allergy might be the answer of this consequence and avoidance of culprit drugs is the best way to improve patient clinical symptoms.


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Case Report/Series (รายงานผู้ป่วย)