Toxic Epidermal Necrolysis Associated with Misoprostol: A Case Report

Abstract

Misoprostol, a synthetic prostaglandin E1 analog, is currently used for medical termination of pregnancy. In the summary of the product characteristics of different market authorization holders of misoprostol tablets, approved by major regulators, serious mucocutaneous reactions, including toxic epidermal necrolysis are not documented as adverse effects. We are now reporting an unusual case of toxic epidermal necrolysis following the use of misoprostol 200 mcg tablets prescribed for termination of a pregnancy. A 25-year-old grand multipara woman from the Gash-Barka region of Eritrea visited Tesseney hospital with a history of amenorrhea that lasted for four months. She was admitted as a case of missed abortion for medical termination of pregnancy. Following three doses of misoprostol 200 mcg tablet the patient developed toxic epidermal necrolysis. Except misoprostol, no other possible alternatives that could explain the condition were identified. Accordingly, the adverse effect was judged to be possibly related to misoprostol. The patient recovered after four weeks of treatment without sequelae. Toxic epidermal necrolysis could, therefore, be a possible adverse effect of misoprostol that needs to be further investigated with better epidemiological studies.

Keywords:

• missed abortion
• misoprostol
• toxic epidermal necrolysis
• Eritrea

Ethics Approval and Consent to Participate

Obtaining ethical clearance from the Ministry of Health’s Ethical Clearance and Protocol Review Committee is not required for case reports. Informed consent was obtained from the patient to publish her anonymized personal details and accompanying images in an international journal.

Acknowledgments

We would like to thank Dr. Henok Tekie, Dr. Ghide Gebreweld, Dr. Tsegezab Kiflezghi, Dr. Abdulaziz Mohammed Seid, and Abel Abraham, BSN from Tesseney Hospital for their comments and valuable insights.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

No funding was used for this study.