Our case represents a previously unreported, fatal complication of cardiac catheterization. We report a fatal case of toxic epidermal necrolysis (TEN) involving a majority of the body surface of this patient as well as a significant portion of his upper gastrointestinal tract. TEN was induced by the nonionic radiocontrast agent used in the cath. Mr. W was a 62-year-old male, who underwent outpatient cardiac catheterization for unstable angina. He had a history of DMII, hyperlipidemia, and renal insufficiency. The cath revealed three-vessel CAD. Two days after returning home, the patient became edematous and blistering of his skin developed. This exanthem eventually resolved. Conservative medical management was pursued, but the patient continued to have symptoms. Four months later, he was admitted for a second cardiac catherterization. He was pretreated with prednisone, diphenhydramine, and ranitidine. Intravenous fluids and N-acetylcysteine were also administered. Findings once again revealed three-vessel disease. Several hours later, the nursing staff noted a generalized red rash, and a fever to 102 F. Within two days, his skin began to slough off near the neck and upper torso. The desquamation spread, reaching his buccal mucosa. The dermatology service took skin biopsies, which were consistent with toxic epidermal necrolysis. He was transferred to the regional burn center. There, he was diagnosed with 70% total BSA involvement. He became hypotensive, bacteremic and required vasopressor support and sustained a myocardial infarction and respiratory failure. The patient began having hematemesis and passing hematochezia, and a 6-gram drop in hemoglobin was noted. Upper endoscopy revealed diffuse gastritis. A PPI infusion was begun. Several days later, his nasogastric tube which yielded large amounts of bright red blood, prompting repeat EGD. This time, sloughing of his esophageal and gastric mucosa was noted, consistent with GI involvement of TEN. Compared with his prior EGD, there was a marked progression of a diffuse, confluent gastritis and duodenitis with ulceration. The mucosa sloughed readily upon any contact with instrument or lavage. The entire upper GI tract from upper esophagus through duodenum was involved and bleeding. Renal failure developed requiring dialysis. Upon request of the family, care was withdrawn. The patient expired twenty-one days after his second cardiac catheterization.