Vancomycin-Induced Toxic Epidermal Necrolysis in a Patient with End-Stage Renal Disease: A Case report

Abstract

Toxic Epidermal Necrolysis (TEN) is a rare, life-threatening mucocutaneous hypersensitivity reaction, most often triggered by drugs. We report a case of a 60-year-old woman with End-Stage Renal Disease (ESRD) on intermittent hemodialysis who developed TEN following vancomycin exposure. The patient initially presented with buccal swelling and Upper Gastrointestinal Bleeding (UGIB), followed by rapidly progressive desquamative skin lesions involving over 80% of her body surface area. Management required a multidisciplinary approach including dermatological care, critical care support, parenteral nutrition and renal replacement therapy with minimal anticoagulation. Despite aggressive supportive care, the patient died from complications related to progressive TEN and sepsis. This case highlights the risk of Severe Cutaneous Adverse Reactions (SCARs) in ESRD patients, the importance of early recognition of atypical presentations and the complexities of managing TEN in the setting of renal impairment.