Introduction

A severe and potentially life-threatening cutaneous reaction known as toxic epidermal necrolysis (TEN) may occur as a result of drug administration. The incidence of this event is quite low, with only two instances per million population per year. The sudden onset of necrosis in the epidermis is characterized by the shedding of skin to a greater or lesser extent [1,2].

Celecoxib is a non-steroidal anti-inflammatory drug (NSAID) that specifically inhibits cyclooxygenase-2 (COX-2) at the doses used in clinical practice (200-400 mg/day). COX-2 is the inducible isoform of cyclooxygenase, upregulated in response to pro-inflammatory stimuli, and is widely recognized as the principal source of the prostanoid mediators driving pain, inflammation, and fever. By selectively targeting this pathway, celecoxib delivers anti-inflammatory and analgesic effects while sparing the physiological functions mediated by other prostaglandin synthesis pathways.

It is commonly prescribed for alleviating arthralgia because of its superior gastrointestinal tolerability. Moreover, it may also cause cutaneous reactions, most of which are harmless. The medical literature has documented fewer than 10 instances of acute generalized exanthematous pustulosis (AGEP) [3-5]. TEN secondary to celecoxib is poorly documented.

In this report, we describe a case of Lyell syndrome (TEN) that occurred following the use of celecoxib. This case is reported because of the rarity of this severe reaction, the extensive use of celecoxib, and the need to raise clinicians' awareness of potentially life-threatening cutaneous toxicity, even with drugs generally considered safe.