The Consideration for an Unlikely Culprit Drug (Betahistine) Inducing Toxic Epidermal Necrolysis: A Case Report

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Abstract

Betahistine is frequently used in treating conditions involving dizziness and has been administered to more than 130 million patients since its release in 1968 1 .There has been only one previous report of betahistine-induced drug eruption 2 .We present a case of toxic epidermal necrolysis (TEN) wherein the result of betahistine drug-induced lymphocyte stimulation test (DLST) was positive.An 85-year-old woman had been taking betahistine for 13 years for Meniere's disease.Three weeks before visiting our hospital, she developed a macular rash over her entire body.Suspecting an infectious disease, she was treated with lincomycin.The administration of betahistine continued even after skin eruptions appeared.She was later referred to our department with a 39C fever.Erythema, blisters, and erosions were observed over her entire body and oral cavity (Fig. 1).Blood tests, including tests for mycoplasma, herpes simplex virus, and cultures failed to indicate infection.Histopathological examination revealed extensive necrosis and thinning of the epidermis, which was detached from the dermis (Fig. 2).On the next day after admission, the area of skin erosion exceeded 70% of the entire body, we diagnosed this condition as TEN.Discontinuing betahistine medication, methylprednisolone 1 g was infused for 3 days, and subsequently, immunoglobulin 400 mg/kg was infused for 5 days to improve her symptoms after 3 weeks.The stimulation index (SI) of the DLST for betahistine was high (442%; reference index in the Japanese population, <180%) at admission to hospital while the result of lincomycin

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