Introduction

Toxic epidermal necrolysis (TEN) represents a severe, life-threatening dermatological emergency that requires immediate recognition and intervention. Recently, clinicians identified a rare case of furosemide-induced toxic epidermal necrolysis in a one-year-old female patient from Eastern Uganda. This occurrence underscores the potential for common loop diuretics to trigger catastrophic cutaneous reactions in the pediatric population.

The Clinical Presentation

Furthermore, the patient exhibited a generalized skin eruption just two days after receiving a single furosemide injection. Upon arrival at the medical facility, doctors observed extensive skin sloughing on the face, trunk, and limbs. Notably, the reaction involved 60% of her total body surface area. Consequently, the medical team initiated aggressive supportive care to manage the systemic effects of the disease. However, the child tragically died at home after her parents chose to leave the hospital against medical advice.

Clinical Significance of Furosemide-induced Toxic Epidermal Necrolysis

Specifically, the chemical structure of furosemide explains this dangerous adverse event. Furosemide shares structural similarities with sulfonamide antibiotics. Therefore, patients with known hypersensitivities to sulfa drugs may face an increased risk of cross-reactivity. Additionally, clinicians should always monitor patients for signs of fever or skin tenderness following any new drug administration. Moreover, early withdrawal of the suspected causative agent remains the most critical step in improving survival rates. High-quality supportive care in a specialized burn unit or intensive care facility often provides the best chance for recovery.

Frequently Asked Questions

Can furosemide cause toxic epidermal necrolysis?

Yes, although rare, furosemide can trigger toxic epidermal necrolysis. This risk stems from its structural similarity to sulfonamides. Clinicians must maintain high vigilance for skin peeling or mucosal erosions after giving this diuretic.

What is the primary treatment for pediatric TEN?

Treatment primarily involves immediate cessation of the offending drug and intensive supportive care. This includes fluid resuscitation, nutritional support, and meticulous wound management, often within a specialized burn center.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Nakubulwa C et al. Toxic epidermal necrolysis following a furosemide injection: a case report. J Med Case Rep. 2026 May 15. doi: 10.1186/s13256-026-06108-6. PMID: 42141491.

Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39.

Mockenhaupt M. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol. 2011;7(6):803-15.