Toxic Epidermal Necrolysis Induced by a Medicinal Plant: Ziziphus mucronata

Abstract

Introduction: The fruits of the jujube tree of the genus Ziziphus, which are mostly edible, are used in traditional medicine for the treatment of certain infectious, urinary and metabolic diseases. Some studies have reported hypersensitivity reactions such as urticaria and angioedema following the consumption of jujube fruits. We report a case of toxic epidermal necrolysis caused by Ziziphus mucronata. Case Report: A 17-year-old girl was hospitalized for a necrotic bullous rash to more than 80% of body surface with a mucosal involvement. These symptoms appeared 18 days after taking the powdered fruit of the jujube tree Ziziphus mucronata to treat enuresis. She did not take any modern medication three months before being admitted to the hospital. Healing of cutaneous and mucosal lesions was obtained after stopping the plant and symptomatic treatment. Conclusion: Plant of the genus Ziziphus contains chemical compounds (alkaloid, tannins, flavonoids, terpene derivatives), which are known for being toxic and allergic to the skin. Their mechanisms of action may be pharmacological linked to overdosage or due to immunological reactions responsible for toxic epidermal necrolysis.