Dear Editor, Toxic epidermal necrolysis (TEN) is usually the maximal form of a bullous drug reaction. Frequent elicitors are allopurinol, sulfonamides, carbamazepine, lamotrigine, phenytoin, barbiturates, sulfasalazine, nevirapine and oxicam-type non-steroidal anti-inflammatory drugs (NSAIDs). 1 No therapeutic gold standard has yet been established for TEN. Immediate withdrawal of all potentially eliciting medications is important as an essential causal measure in TEN. In addition to supportive intensive therapy, adequate local treatment under sterile conditions is decisive in minimizing the risk of sepsis. Regular ophthalmological and urological control examinations promote early recognition or prevention of ocular synechiae and scarred urethra strictures. High-dose systemic glucocorticoids appear to have a favorable effect–if any at all–only in the first days of exanthema development, while later they increase the danger of sepsis. 2 There have been individual reports of successful administration of the tumor necrosis factor (TNF)-o antibody infliximab in treating TEN. 3–6

Etoricoxib (Arcoxia; MSD, Haar, Germany) is a highly-selective cyclooxygenase-2 inhibitor NSAID and is used in clinical practice mainly for the treatment of osteoarthritis, rheumatoid arthritis and pain. Only isolated case reports of serious cutaneous drug reactions, such as erythema exsudativum multiforme-like exanthema or acute generalized exanthematous pustulosis, have been published so far. 7, 8 We are reporting on the successful treatment with infliximab of a case of TEN following treatment with etoricoxib and wish in this connection to again point out the evident and rapid efficacy of TNF-o blockade. After 3 weeks of continuous po administration of etoricoxib at a dose of 60 mg⁄ day for pain treatment of a herniated disk–with no concurrent medications–a 31-year-old man was hospitalized because