Hypersensitivity to Cefpodoxime Resulting in Toxic Epidermal Necrolysis in an Infant: A Case Report

Background: Toxic epidermal necrolysis (TEN) is a rare, life-threatening mucocutaneous adverse drug reaction, most commonly triggered by medications. While antibiotics such as penicillins and sulfonamides are well-known culprits, cephalosporins are infrequently implicated, and reports of cefpodoxime-induced TEN, particularly in infants, are exceedingly rare. Clinical Description: We present the case of a 3-month-old male infant who developed TEN following the administration of oral cefpodoxime proxetil prescribed for fever and cough. Within 48 h of initiating therapy, the infant manifested extensive epidermal detachment involving over 30% of the body surface area, including the face, neck, trunk, and extremities. Mucosal involvement was prominent, with conjunctivitis and erosions affecting the oral cavity and perianal region. The clinical diagnosis of TEN was established based on characteristic skin detachment, mucosal involvement, and temporal association with recent drug exposure. Management and Outcome: Cefpodoxime was withdrawn. The infant was managed with intravenous dexamethasone, antihistamines, and meticulous supportive care, including fluid and electrolyte management, infection prevention, and topical wound care. Re-epithelialization progressed steadily, and the patient achieved complete recovery within 2 weeks, with no subsequent complications. Conclusion: This case creates the awareness that even benign drugs such as cefpodoxime proxetil, usually considered safe, have the potential to cause hypersensitivity reactions such as TEN, especially in young infants. Pediatricians should be cautious in the use of such drugs.