A patient with chronic active hepatitis and membranous glomerulonephritis acquired an acute, fatal illness characterized by a toxic erythematous desquamative dermatitis with bulla formation, fever, diarrhea and hepatic and renal failure. The cutaneous histopathologic appearance resembled that found in erythema multiforme, toxic epidermal necrolysis and the acute graft vs. host reaction. The cutaneous eruption may have been part of a widespread autoimmune reaction possibly triggered by drugs [prednisolone furosemide, triamterene, metolazone, nitrazepam] or infection.