Compound paracetamol tablets(II) caused epidermolysis bullosa and multisystem damage

A 48-year-old female patient took oral compound paracetamol tablets(II) 3 tablets for pain due to cold. She developed skin rash on her trunk accompanied by pruritus after 4 hours. Four days later, swelling, ulceration, and fever appeared on her whole body skin. The next day, she developed large area of the oral mucosal erosion, scattered erythema and flaccid blisters on her face, body, arms and legs, and partial exfoliation. The result of examination of Nikolsky′s sign was positive. Laboratory test showed the following values: white blood cell 8.1×109/L, neutrophils 0.76, platelet count 45×109/L, red blood cell 6.51×1012/L, alanine aminotransferase 161 U/L, aspartate aminotransferase 155 U/L, total protein 45 g/L, albumin 28 g/L, and globulin 17 g/L. The patient was diagnosed as epidermolysis bullosa, thrombocytopenia, and drug-induced liver injury. She was treated with oral loratadine 10 mg once daily, IV infusion of 10% calcium gluconate 20 ml, and dexamethasone 15 mg once daily. On day 5, the skin lesions relieved and dexamethasone was reduced to 10 mg once daily. An IV infusion of ceftazidime 2.0 g twice daily was given. On day 8, the oral mucosa erosion disappeared and skin rashes gradually subsided, the temperature declined to normal. The result of reexamination showed platelet count 225×109/L, alanine aminotransferase 92 U/L, aspartate aminotrans-ferase 45 U/L. Key words: Acetaminophen; Drug eruptions; Drug-induced liver injury