Severe Cutaneous Adverse Reaction (SCAR) represents the spectrum of adverse drug 
reactions from erythema multiforme, Stevens - Johnson syndrome (SJS) to Toxic 
Epidermal Necrolysis (TEN). A 55 year old lady presented in a toxic state with 
peeling of skin, blisters on the body of seven days duration following 
medications taken for fever and pulmonary tuberculosis. When referred to our 
institution, she was diagnosed as TEN. Immediately the suspected medications 
were stopped. The essential investigations were done including the screening for 
immunosuppression, which was found to be negative. The patient was treated 
symptomatically with emphasis on skilled nursing care. The patient's skin 
condition improved gradually but tuberculosis progressively worsened over three 
months. Thus patient was reinvestigated for seropositivity and was found to be 
positive. Considering the benefit - risk ratio along with the advice of the 
pulmonologist, a decision was made to give her a rechallenge test, first for 
antitubercular drugs and later for antipyretics. The patient developed SJS 
within two days of starting isoniazid (INH). On withdrawal of INH the patient 
recovered.