Methimazole-induced epidermolysis bullosa

A 52-year-old male patient with severe craniocerebral injury and hyperthyroidism was given nasal feeding methimazole 10 mg twice daily and propranolol 10 mg thrice daily. On day 4, the patient developed red papules which involve neck, body, and forearm. Methimazole′s dosage was halved and he received an IV infusion of dexamethasone 10 mg twice daily and nasal feeding loratadine 10 mg once daily. On day 6, the patient developed maculopapular eruptions on the face and neck, some rashes fused into lamella, blisters emerged on the neck and trunk, accompanied by high fever. Bronchoscopy showed the airway congestion, erosion and bloody sputum. Methimazole was withdrawn and anti-anaphylactic treatment was continued. On day 7, a large area of exfoliation appeared. Methimazole-induced epidermal necrolysis was diagnosed. He received IV infusions of human immunoglobulin 20 g once daily and methylprednisolone 60 mg twice daily. On day 12, wound exudates were reduced. Human immunoglobulin was withdrawn and the dosage of methylprednisolone was changed to 40 mg twice daily. One month later, the body skin base was bright red and a small amount of purulent secretions appeared. Methylprednisolone was withdrawn. Six months later, the surface of wound and scars healed. Key words: Methimazole; Epidermolysis bullosa acquisita