Early Immunosuppression in Toxic Epidermal Necrolysis: A Key Strategy for Optimal Outcomes

Abstract Toxic epidermal necrolysis (TEN) is a severe, life-threatening mucocutaneous drug reaction characterized by extensive epidermal necrosis and mucosal involvement. Here, we report a case of TEN in a previously healthy 22-year-old female with no previous comorbidities who developed rapidly spreading erythema, flaccid bullae, and mucosal ulcerations covering 70%–90% of her body surface area after receiving acyclovir, levofloxacin, ibuprofen, and miconazole for a febrile illness. Prompt initiation of oral cyclosporine and comprehensive multidisciplinary supportive care, including intensive care and specialized burn management, led to complete mucocutaneous recovery within 3 weeks. This case highlights the critical importance of early clinical suspicion, immediate cessation of all potential offending agents, and prompt immunosuppressive therapy with cyclosporine, even when the exact trigger is uncertain.