On New Year’s Eve, a young man from Wesley Chapel, Florida, died of a rare drug reaction called Toxic Epidermal Necrolysis (TEN). Though TEN is already a very rare disorder, this case was particularly unusual, as the teenager lacked a key risk factor for Toxic Epidermal Necrolysis.

The sixteen-year-old developed the reaction right before the Christmas holiday, when he came down with flu-like symptoms and displayed a severe rash with blisters and patches of dying skin. On Christmas Eve, he seemed to be improving, and his family briefly left his side to partake in several holiday traditions. Unfortunately, the next day, the teenager’s fever spiked to 106 degrees Fahrenheit, causing brain death. He died on New Year’s Eve.

Toxic Epidermal Necrolysis is a particularly severe form of Stevens Johnson Syndrome or SJS.

In Stevens Johnson Syndrome and Toxic Epidermal Necrolysis, the immune system goes haywire and starts attacking the skin, the same way the body normally attacks an invading infection. This causes a severe rash, with sores, blisters and ulcers.

A severe case of Stevens Johnson Syndrome is considered Toxic Epidermal Necrolysis when patches of skin begin to die and slough off, leaving burn-like wounds over a certain percentage of the body (there is some overlap in definitions, but roughly 30% of the body covered in burn-like wounds is usually the threshold for Toxic Epidermal Necrolysis).

SJS and TEN are rare, making it hard to study them. Additionally, their rarity means that physicians often fail to diagnose these conditions quickly, potentially complicating treatment.

The fact that these disorders share early symptoms with much more common diseases like the flu, chicken pox, and herpes further complicate treatment. But even for a rare disorder like Toxic Epidermal Necrolysis, this case is odd.

Nearly all cases of Stevens Johnson Syndrome and Toxic Epidermal Necrolysis are connected with exposure to prescription or over-the-counter drugs. Antibiotics like Zithromax and even common medications such as Tylenol and Advil have been linked to causing the skin reaction.

It is unknown why, but rare combinations of genes appear to play a role, though even with genetic testing it is difficult to tell who well develop Toxic Epidermal Necrolysis from what drug. Despite this, most cases of SJS and TEN occur when a patient is taking a drug, which seems to trigger the cascade of errors in the immune system that cause Toxic Epidermal Necrolysis.

However, the family of the young man who died from Toxic Epidermal Necrolysis have publically asserted that the he did not take any antibiotics. Cases like this are not unheard of, but unusual, even for this rare disorder.

SJS Lawsuits

A number of drugs including antibiotics like Zithromax, as well as seizure drugs, painkillers, and others have been linked to Toxic Epidermal Necrolysis and Stevens Johnson Syndrome.

Drug makers have been accused of failing to properly warn people that they can develop these severe reactions after taking these drugs. A number of high-profile lawsuit settlements have been awarded to victims of drug-induced Stevens Johnson Syndrome who were able to prove that their injuries were caused by the negligence of the drug manufacturer.