Recurrent fatal drug-induced toxic epidermal necrolysis (Lyell's syndrome) after putative beta-lactam cross-reactivity: Case report and scrutiny of antibiotic imputability

Crit Care Med. 2002 Nov;30(11):2580-3. doi: 10.1097/00003246-200211000-00029.


Objective: A series of antibiotics may be responsible for toxic epidermal necrolysis. We report two successive episodes of toxic epidermal necrolysis in the same patient. Drug imputability criteria designate a cross-reactivity between two antibiotics of different chemical classes but sharing the beta-lactam ring in common.

Design: Descriptive case report and review of the literature.

Setting: Medical intensive care unit in a university medical center. PATIENT AND MAIN RESULTS: A 75-yr-old woman developed a first episode of toxic epidermal necrolysis (involving 40% of the body surface) after intake of cefotaxime, a third-generation cephalosporin. Perfusions of high-dose immunoglobulins rapidly improved the lesions, followed by partial reepithelialization in 5 days. Sepsis required the administration of meropenem, which is a carbapenem antibiotic. The epidermal destruction immediately recurred, with extension to previously uninvolved skin areas and fatal consequences.

Conclusions: The beta-lactam ring present in cephalosporins and carbapenems represents the putative chemical structure responsible for the presently reported cross-reactivity to two antibiotics of different classes. Drugs having any chemical similarity to the initial culprit compound should be strictly avoided when possible in the management of toxic epidermal necrolysis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Bacterial Agents / adverse effects*
  • Anti-Bacterial Agents / pharmacology
  • Cefotaxime / adverse effects*
  • Cefotaxime / pharmacology
  • Drug Interactions
  • Fatal Outcome
  • Female
  • Humans
  • Meropenem
  • Stevens-Johnson Syndrome / etiology*
  • Thienamycins / adverse effects*
  • Thienamycins / pharmacology


  • Anti-Bacterial Agents
  • Thienamycins
  • Meropenem
  • Cefotaxime