Cefditoren pivoxil induced toxic epidermal necrolysis: a case report


  • Amarthya S. Racha G. Pulla Reddy College of Pharmacy, Hyderabad, Telangana, India
  • P. Ashwani Department of Dermatology and Cosmetology, AIG Hospitals, Telangana, India
  • Polevoina Swarnalatha G. Pulla Reddy College of Pharmacy, Hyderabad, Telangana, India




Cefditoren pivoxil, Erythema multiforme, Steroids, Toxic epidermal necrolysis


Cutaneous adverse drug reactions vary in severity, from mild erythematous skin lesions to life-threatening toxic epidermal necrolysis. Antiepileptics, antipsychotics, antimicrobials, and diuretics are associated with these adverse reactions. We report a case of cefditoren pivoxil-induced toxic epidermal necrolysis in a 46-year-old Indian woman who presented initially with a maculopapular rash that eventually progressed to steroid-refractory toxic epidermal necrolysis. The patient succumbed to her illness on day 33 of the index rash following septic shock.


Lerch M, Mainetti C, Terziroli Beretta-Piccoli B, Harr T. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clin Rev Allergy Immunol. 2018;54(1):147-76.

Phillips EJ, Bouchard CS, Divito SJ. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis-Coordinating Research Priorities to Move the Field Forward. JAMA Dermatol. 2022;158(6):607-8.

Obeid G, Allanore, LV, Wolkenstein P. Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson Syndrome (SJS). Eur Handbook Dermatol Treatments. 2015;971:82.

Alajaji A, Chandra Shekaran J, Mohammed Aldhabbah O, Alhindi HA, Almazyad NS, Aljutayli ZA, et al. Toxic Epidermal Necrolysis (TEN)/Stevens-Johnson Syndrome (SJS) Epidemiology and Mortality Rate at King Fahad Specialist Hospital (KFSH) in Qassim Region of Saudi Arabia: A Retrospective Study. Dermatol Res Pract. 2020;7524726.

Lipovy B, Holoubek J, Hanslianova M, Cvanova M, Klein L, Grossova I, et al. Impact of Antibiotics Associated with the Development of Toxic Epidermal Necrolysis on Early and Late-Onset Infectious Complications. Microorganisms. 2021;9(1):202.

Sassolas B, Haddad C, Mockenhaupt M, Dunant A, Liss Y, Bork K, et al. ALDEN, an algorithm for assessment of drug causality in Stevens-Johnson syndrome and toxic epidermal necrolysis: Comparison with case-control analysis. Clin Pharmacol Ther. 2010;88:60-8.

Lee EY, Knox C, Phillips EJ. Worldwide Prevalence of Antibiotic-Associated Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Systematic Review and Meta-analysis. JAMA Dermatol. 2023;159(4):384-92.

Cohen S, Billig A, Ad-El D. Ceftriaxone-induced toxic epidermal necrolysis mimicking burn injury: a case report. J Med Case Rep. 2009;3:9323.

Torres-Navarro I, Abril-Pérez C, Roca-Ginés J, Sánchez-Arráez J, Botella-Estrada R. A case of cefditoren-induced acute generalized exanthematous pustulosis during COVID-19 pandemics. Severe cutaneous adverse reactions are an issue. J Eur Acad Dermatol Venereol. 2020;34(10):e537-9.

Newkirk RE, Fomin DA, Braden MM. Erythema Multiforme Versus Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Subtle Difference in Presentation, Major Difference in Management. Mil Med. 2020;185(9-10):e1847-50.

Iwai S, Sueki H, Watanabe H, Sasaki Y, Suzuki T, Iijima M. Distinguishing between erythema multiforme major and Stevens-Johnson syndrome/toxic epidermal necrolysis immunopathologically. J Dermatol. 2012;39(9):781-6.

Oakley AM, Krishnamurthy K. Stevens Johnson Syndrome. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2023.

Guay DR. Review of cefditoren, an advanced-generation, broad-spectrum oral cephalosporin. Clin Therap. 2001;23(12):1924-3.

Zhang Z, Li S, Zhang Z, Yu K, Duan X, Long L, et al. Clinical Features, Risk Factors, and Prognostic Markers of Drug-Induced Liver Injury in Patients with Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. Indian J Dermatol. 2020;65(4):274-8.

Castrejon JL, Berry N, El-Ghaiesh S, Gerber B, Pichler WJ, Park BK, et al. Stimulation of human T cells with sulfonamides and sulfonamide metabolites. J Allergy Clin Immunol. 2010;125(2):411-8.

Pichler WJ. Immune pathomechanism and classification of drug hypersensitivity. Allergy. 2019;74(8):1457-71.

Chessman D, Kostenko L, Lethborg T, Purcell AW, Williamson NA, Chen Z, et al. Human leukocyte antigen class I-restricted activation of CD8+ T cells provides the immunogenetic basis of a systemic drug hypersensitivity. Immunity. 2008;28(6):822-32.

Ye LP, Zhang C, Zhu QX. The Effect of Intravenous Immunoglobulin Combined with Corticosteroid on the Progression of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Meta-Analysis. PloS One. 2016;11(11):e0167120.