We reported a 67-year-old male patient with metastatic castration-sensitive prostate cancer (mCSPC) who developed toxic epidermal necrolysis (TEN) after apalutamide endocrine therapy. This patient was in a life-threatening status characterized by persistent high fever and a rash that spread throughout the body. The examination showed he also had liver injury, systemic inflammatory response syndrome. When the initial glucocorticoid and immunoglobulin treatment does not show significant efficacy, TNF antagonist-adalimumab was promptly applied based on the increased serum level of TNF-. Antibiotics against bacteria and fungi were also positively administrated when secondary fungal and bacterial infections were showed up as a result of skin exfoliation. Moreover, nursing intervention of silver ion gauze add brilliance to this comprehensive medication strategy. The patient improved significantly after 15 days of treatment, and his skin gradually returned to normal and remained stable during the follow-up period of 6 months after discharge. This case underlines apalutamide can cause TEN. Early use of glucocorticoids and immunoglobulin, active application of antibiotics and nursing measures have made great contributions to the effective recovery. However, it is worth emphasizing that TNF- antagonist-adalimumab application and comprehensive strategy are the key for the recovery of TEN, which provides an important therapeutic implication for future treatment of TEN.