Toxic Epidermal Necrolysis (TEN)-Like Lupus or TEN in Lupus: A Case Series

Summary: Objectives Toxic Epidermal Necrolysis (TEN)-like lupus is a rare manifestation of lupus erythematosus (LE) characterized by widespread sloughing of the epidermal layer and mucosal ulceration.1,2,3 Due to the rarity of the condition, little is known about disease triggers and differences in treatment outcomes. This study aims to identify characteristics of TEN-like lupus in identified patients, evaluate their clinical course, investigate clinical history and potential inciting factors, and increase literature representations of darker skin types. Methods After receiving approval, we identified patients 18 years old or older with TEN-like lupus seen by UNC Dermatology during UNC Health Medical Center hospitalization from 2013 to 2023. Results We found seven patients with TEN-like lupus. 71% of identified patients were African American. Common findings among patients included interface dermatitis, high antinuclear titers, pancytopenia, and hypocomplementemia. Identified inciting factors included medication exposure and medication holiday. Conclusion Distinguishing characteristics of TEN-like lupus resemble current literature, including high antinuclear titers, pancytopenia, hypocomplementemia, and interface dermatitis.2,4 In many of our patients, medication was a trigger. Further research could investigate differences in histological presentation and clinical course based on trigger. Given the large proportion of African American patients, we also plan to increase literature representation of darker skin types. References: 1. Abdelmouttalib A, Meziane M, Senouci K. Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus: Two cases report. Pan Afr Med J. 2021;38. doi:10.11604/pamj.2021.38.236.27303 2. Ryan E, Marshman G, Astill D. Toxic epidermal necrolysis-like subacute cutaneous lupus erythematosus. Australas J Dermatol. 2012;53(4). doi:10.1111/j.1440-0960.2011.00842.x 3. Roberts EJ, Melchionda V, Saldanha G, Shaffu S, Royle J, Harman KE. Toxic epidermal necrolysis-like lupus. Clin Exp Dermatol. 2021 Oct;46(7):1299-1303. doi: 10.1111/ced.14648. Epub 2021 May 10. PMID: 33760256i. 4. Ting W, Stone MS, Racila D, Scofield RH, Sontheimer RD. Toxic epidermal necrolysis-like acute cutaneous lupus erythematosus and the spectrum of the acute syndrome of apoptotic pan-epidermolysis (ASAP): A case report, concept review and proposal for new classification of lupus erythematosus vesiculobullous skin lesions. Lupus. 2004;13(12). doi:10.1191/0961203304lu2037sa