Toxic Epidermal Necrolysis and Recurrent Implantation Failure: Unveiling a Rare Phenomenon During Pregnancy

Abstract

Hydroxychloroquine (HCQ) is a common treatment for recurrent implantation failure (RIF), which may be associated with diverse side effects. We report a case of a 36-year-old RIF3 pregnant female through in vitro fertilization (IVF) presented to the emergency department with painful, itchy, macular, erythematous, blanchable, and exfoliative skin lesions distributed on the face, upper trunk, and upper limbs. She had been prescribed HCQ about 10 days before embryo transfer for her RIF history. With suspicion of Stevens-Johnson syndrome/Toxic epidermal necrolysis (TEN), HCQ was discontinued, and intravenous immunoglobulins (IVIg), triamcinolone, chlorpheniramine, and body lotion were administered. Considering more than 30 of the total body surface area involvement, within 3 days of treatment, and with favorable improvements, the diagnosis of TEN was confirmed. With the rising popularity of HCQ in immune-related conditions, it is essential to highlight the significance of continuous monitoring for uncommon adverse reactions. The need for vigilance becomes particularly critical in patients requiring immediate intervention to prevent irreversible consequences.