Methotrexate is highly effective for psoriasis vulgaris and is often used as long-term management. Well known for its side effects of myelosuppression and liver toxicity, methotrexate also induces skin ulceration, which often heralds other markers of toxicity.
Dapsone hypersensitivity syndrome (DHS) is an allergic reaction caused by dapsone, one of the components in the WHO leprosy multidrug therapy (MDT), which usually occurs in the fourth-eighth week of the treatment.
Toxic Epidermal Necrolysis (TEN) is acute mucocutaneous reaction characterized with extensive necrosis of epidermis. It is the highest grade of SJS-TEN clinical spectrum, involving necrosis of >30% of body surface area.
Generalized bullous fixed drug eruption (GBFDE) is a rare presentation of fixed drug eruption. Fixed drug eruption can present with bullae but can present in a widespread distribution as GBFDE.
We report a case of Steven Johnson Syndrome-Toxic Epidermal Necrolysis (SJS-TEN) overlap in a patient with systemic lupus erythematosus (SLE). Identified drugs were amoxicillin-clavulanic acid and ibuprofen however, connective tissue diseases such as SLE contributed to this as well.
Generalized bullous fixed drug eruption (GBFDE) is characterized by generalized erythema and appearance of multifocal ill-defined hyperpigmentation, and flaccid bullae which easily rupture and exhibit epidermal detachment. It may be clinically indistinguishable from stevens-johnson syndrome (SJS), especially on initial presentation.