Tirabrutinib-associated toxic epidermal necrolysis: a case report and review of the literature

Tirabrutinib, a Bruton tyrosine kinase (BTK) inhibitor, has shown efficacy in recurrent or refractory diffuse large B-cell lymphoma (DLBCL). However, severe drug eruptions, including toxic epidermal necrolysis (TEN), have been reported. We present a case of a 74-year-old man with refractory DLBCL who developed TEN after 1 month of tirabrutinib treatment. Severe drug eruptions linked to tirabrutinib are rare, with only three cases reported, including ours. Tirabrutinib's selective BTK inhibition may activate cytotoxic CD8⁺ T cells, contributing to Stevens-Johnson syndrome/TEN pathogenesis. Further studies are needed to clarify the mechanisms and develop better diagnostic approaches for BTK inhibitor-related drug eruptions.