Case 14-1996: A 66-year-old woman with toxic epidermal necrolysis and a fatal course

Presentation of Case A 66-year-old woman was admitted to the hospital because of possible toxic epidermal necrolysis. Her medical history included primary hypothyroidism, allergy to penicillin, long-standing hypertension, inflammatory arthritis with a positive test for antinuclear antibodies, and progressive, idiopathic chronic renal failure. The arthritis had been treated for several years with prednisone. Eight months before admission, acute renal tubular necrosis developed during a urinary tract infection, and insulin was prescribed for adult-onset diabetes mellitus that had responded for six years to oral hypoglycemic agents. Four months before admission, extracorporeal hemodialysis was initiated. Six weeks before admission, methotrexate was begun; . . .