Toxic Epidermal Necrolysis and Steven-Johnson Syndrome During the Postpartum Period - A Literature Review with a Rare Case Presentation

Sep 30, 2026

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Toxic Epidermal Necrolysis (TEN) and Steven–Johnson Syndrome (SJS) are rare, dangerous mucocutaneous emergencies driven by immune reactions, potentially associated with pharmaceuticals such as NSAIDs, antibiotics, and antiretroviral drugs. During the postpartum period, women receive multiple medications for pain and infection susceptibility, increasing risk for allergy and immune complications. The review and rare early postpartum case highlight early diagnosis, multidisciplinary care, and intravenous immunoglobulin therapy to achieve rapid recovery, while emphasizing vigilance with antibiotics and key differential diagnosis from sepsis.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages17

Reading Time43 min

AccessFree to download

Abstract

Introduction

Case Report and Review

Results

Conclusions

1. Introduction

2. Case Report

Review Toxic Epidermal Necrolysis and Steven–Johnson Syndrome During the Postpartum Period: A Literature Review with a Rare Case Presentation Natalia Katarzyna Mazur-Ejankowska 1,2,3, *, Maciej Ejankowski 1,2, Magdalena Emilia Grzybowska 1,2, Jakub Z˙ółkiewicz 4,5, Ewa Gostkowska 6, Wioletta Bara ´nska-Rybak 4,5 and Dariusz Grzegorz Wydra 1,2 Academic Editor: Alexander C. Katoulis Received: 3 November 2025 Revised: 29 November 2025 Accepted: 15 December 2025 Published: 19 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Gynecology, Obstetrics and Neonatology, Medical University of Gdansk, 80-210 Gdansk, Poland 2 Clinic of Obstetrics and Gynecology, Gynecological Oncology and Endocrine Gynecology, University Clinical Centre, 80-952 Gdansk, Poland 3 First Doctoral School, Medical University of Gdansk, 80-210 Gdansk, Poland 4 Department of Dermatology, Venereology and Allergology, Medical University of Gdansk, 80-210 Gdansk, Poland 5 Clinic of Dermatology, Venereology and Allergology, University Clinical Centre, 80-952 Gdansk, Poland 6 Gynecological and Obstetrical Practice, 80-244 Gdansk, Poland * [Correspondence: natalia.mazur@gumed.edu.pl](Correspondence: natalia.mazur@gumed.edu.pl); Tel.: +48-500475424 Abstract Introduction: Toxic Epidermal Necrolysis (TEN) and Steven–Johnson Syndrome (SJS) are rare yet dangerous dermatological emergencies presenting as necrosis of the skin and mucous membranes due to an immune reaction which maybe associated with the use of pharmaceuticals—predominantly non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics, and antiretroviral drugs. During the postpartum period, women are administered numerous pharmaceuticals, including NSAIDs, analgesics, and antibiotics, due to pain and their susceptibility to infections, exposing them to potential adverse effects including allergies and immune reactions. Case Report and Review: The case reported here is a rare description of a patient in the early postpartum phase who presented with epidermal necrolysis whilst remaining hospitalized after a cesarean delivery. The multidisciplinary approach, early diagnosis, and treatment ensured the patient’s full recovery. Intravenous immunoglobulin treatment resulted in a rapid therapeutic effect. This literature review offers an insight into the epidemiology, diagnostic process, and treatment of this infrequent dermatological syndrome during the postpartum period. Results: Antibiotic treatment is a common culprit of TEN in this population; hence, clinicians should remain vigilant during antibiotic administration. Differential diagnosis with toxic shock syndrome is crucial, as TEN and SJS symptoms may mimic sepsis, which is a more common diagnosis in the postpartum period. Conclusions: The condition of the skin during the postpartum period should be closely monitored, as some systemic diseases may manifest abruptly as profound, postpartum hormonal changes affect the immunological response. Upon the discovery of suspicious skin lesions concomitant with systemic symptoms, an immediate multidisciplinary approach involving obstetricians and dermatologists is key to a rapid diagnosis and treatment to avoid maternal mortality. Keywords: Toxic Epidermal Necrolysis (TEN); Steven–Johnson Syndrome (SJS); Lyell’s syndrome; postpartum; obstetrics; polypharmacy; complication 1. Introduction Toxic Epidermal Necrolysis (TEN) is a severe drug-induced febrile mucocutaneous reaction. TEN, Steven–Johnson Syndrome (SJS), and SJS/TEN overlap syndrome are considered to form a spectrum of one disease with a varying severity [1] . TEN causes epidermal detachment of more than 30% of the body surface area (BSA) . SJS involves under 10% of the BSA and SJS/TEN overlap is diagnosed in intermediate cases [2] . Antibiotic

FAQs

What triggers Toxic Epidermal Necrolysis and Steven–Johnson Syndrome during the postpartum period?

Immune reactions may be associated with medications, especially NSAIDs, antibiotics, and antiretroviral drugs. In the postpartum period, frequent medication use for pain and infection risk can contribute to potential adverse reactions.

Why is antibiotic use an important concern in this postpartum population?

The review states that antibiotic treatment is a common culprit of TEN in this population. Clinicians should therefore remain vigilant when antibiotics are administered.

How do clinicians distinguish TEN/SJS from other postpartum conditions?

Differential diagnosis with toxic shock syndrome is crucial because TEN and SJS symptoms may mimic sepsis, which is more common postpartum. This supports prompt and accurate diagnosis and treatment.

Sep 30, 2026

Uploaded by Ben