Hydroxychloroquine-associated, photo-induced toxic epidermal necrolysis E. L. Callaly, O. FitzGerald* and S. Rogers Departments of *Rheumatology and Dermatology, St. Vincent’s University Hospital, Elm Park, Dublin, Ireland Summary A patient developed toxic epidermal necrolysis (TEN), which was triggered by sun exposure while the patient was on long-term hydroxychloroquine. Phototoxic and photoallergic reactions are known to occur with hydroxychloroquine, but, to our knowledge, this is the first reported case of photo-induced TEN associated with the drug. We describe a case of life-threatening toxic epidermal necrolysis (TEN), triggered by sun exposure while the patient was on long-term hydroxychloroquine. Photo- toxic and photoallergic reactions are known to occur with hydroxychloroquine but, to our knowledge, this is the first reported case of photo-induced TEN associated with hydroxochloroquine. Report A 29-year-old woman was admitted with a 1-week history of facial swelling and a painful erythematous eruption involving the trunk and limbs with associated lethargy and anorexia. Ten days previously, she had been sunburnt while on a Mediterranean cruise. She had been taking hydroxychloroquine 200 mg BD for the preceding 3 years for Sjogren’s syndrome (SS) and gabapentin 300 mg three times daily for 2 years for postherpetic neuralgia. The symptoms of SS had pre- sented 7 years earlier, with three episodes of bilateral parotitis and associated xeropthalmia. The diagnosis was confirmed with serology and a labial biopsy. She had not previously experienced any increased sensitivity to sunlight. On admission, the patient was in distress from skin pain. She was apyrexial but tachycardic, with a stable blood pressure. With the exception of areas that had been shielded by a swimming costume, there was widespread erythema on the trunk and limbs, and red, hot, peeling skin on the back and thighs (Figs 1 and 2). There were large bullae on the face, breasts, abdomen, lateral aspect of the shoulders and dorsum of the feet. Nikolsky’s sign was positive. There was intense haem- orrhagic crusting of the lips, buccal mucosa and tongue, and the eyelids were eroded with intense conjunctival injection. There was no apparent involvement of the vulva, but the patient reported dysuria. Figure 1 Red peeling skin on the neck, back and arms. Correspondence: Dr Elizabeth L. Callaly, Department of Pathology, Mater Misericordiae Hospital, Eccles Street, Dublin 7, Ireland. E-mail: ecallaly@rcsi.ie Conflict of interest: none declared Accepted for publication 16 May 2007 Clinical dermatology • Concise report doi: 10.1111/j.1365-2230.2008.02704.x Ó 2008 The Author(s) 572 Journal compilation Ó 2008 Blackwell Publishing Ltd • Clinical and Experimental Dermatology, 33, 572–574