A 59-year-old man was admitted to our hospital for the treatment of centrally located squamous cell-lung carcinoma and pulmonary tuberculosis. The computed tomography (CT) scans showed that the malignant lesion, located between the left upper and lower lobes, had invaded the left pulmonary artery ( Figure 1 ). Pathological and etiological findings revealed a combined diagnosis of squamous cell-lung cancer (T3N0M0) and pulmonary tuberculosis. Anti-tuberculosis therapy, which including Isoniazid (300 mg per day), Rifampicin (450 mg per day), Ethambutol (750 mg per day), and Pyrazinamide (1250 mg per day), without any adverse events, was administered to cure the pulmonary tuberculosis. Neoadjuvant therapy, including sintilimab and conventional chemotherapy, was administered to achieve a complete response (CR) or partial response (PR). After three cycles of neoadjuvant therapy, the patient underwent video-assisted thoracoscopic surgery (VATS) left lower lobectomy, because the malignant lesion had shrunk and the left pulmonary artery had been isolated from the tumor. No cutaneous toxicity was observed during the first three cycles of neoadjuvant therapy. According to the post-operative pathologic results, the neoadjuvant therapy resulted in a PR. Therefore, the sintilimab and conventional therapy were continued as post-operative adjuvant therapy.
Ten days after the post-operative adjuvant therapy, the patient suffered severe TEN, which rapidly progressed to cover >50% of the skin. TEN was associated with rashes of the trunk, pruritus, and a fever of >40 C. Massive maculopapular were observed in the chest and abdomen. Oral mucositis was also observed. The cutaneous lesions accounted for approximately 95% of the whole body surface ( Figure 2 ). No pulmonary, gastrointestinal, or cardiac AEs were presented in this patient. Physical examinations showed the positive Nikolsky sign. Laboratory results showed that the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), C-reactive protein was 3.48, 217.39 and 53.28, respectively. The white blood cell was lower than normal because of chemotherapy. Due to financial constraints, no further skin biopsies were taken for pathological analysis. Because of the shortage of pathologic results, a dermatologist diagnosed TEN due to the history of sintilimab use, epidermal necrolysis, positive Nikolsky sign, high NLR and PLR, and so on. Exfoliative dermatitis, which was similar to TEN was suspected, but the Nikolsky sign was negative. Intravenous methylprednisolone (40 mg per day) was administered to this patient immediately. Additionally, prednisone (60 mg per day) was prescribed for out-patient use. Supportive management included wound care, nutritional supplementation, and analgesic use. Furthermore, Levofloxacin (500 mg per day) was administered to treat infections resulting from damage to the skin barrier. Four weeks after discharge from the hospital, we observed gradual healing of the epidermis with slight scars. Anti-tuberculosis therapy was continued for 4 months after diagnosis of TEN without any adverse events. The timeline of the treatment of the patient was presented in  Figure 3 .