Toxic epidermal necrosis associated with phenobarbitone: a case report and brief review of the literatures

Abstract Background Toxic epidermal necrolysis (TEN)/Stevens–Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, T-cell mediated delayed type IV hypersensitivity reaction and universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS. Case report We report a 14-year-old asthmatic male patient admitted to a local hospital for an acute exacerbation of asthma, after he presented with shortness of breath, cough, and fever. He was treated with bronchodilator and antibiotics. On subsequent days, the patient developed new onset generalized tonic clonic seizure in the hospital for which he was started on phenobarbitone of 100 mg twice daily. Two weeks after initiation of phenobarbitone, the patient developed extensive blistering skin eruptions; which subsequently exfoliated unevenly. Associated with the hypersensitivity skin reaction, the patient reported low grade fever, sore throat, and dysphagia. The exfoliation also involved oral and conjunctival mucosa; with estimated 65% body surface area involvement. The laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days the patients’ clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharged improved after ten days of intensive care unit. Conclusion In summary, the present case describes, a 14-years-old young child with history of asthma and seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the better prognosis observed in pediatric population with TEN.

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Phenobarbitone Induced Toxic Epidermal Necrosis in a Young Patient - A Rare Clinical Presentation: A Case Report and Brief Review of the Literatures

10.21203/rs.3.rs-458796/v1 ◽

2021 ◽

Author(s):

Biniyam A. Ayele ◽

Kemal Ali ◽

Eliyas Mulatu

Keyword(s):

Case Report ◽

Asthmatic Patient ◽

Wound Care ◽

Tube Feeding ◽

Whole Body ◽

Stevens Johnson Syndrome ◽

Low Grade ◽

First Case ◽

Epidermal Necrosis ◽

New Onset

Abstract Background: Toxic epidermal necrolysis (TEN)/ Stevens-Johnson syndrome (SJS) is the spectrum of severe, acute, mucocutaneous, Ig E mediated hypersensitivity reaction; universally related to different drugs. Phenobarbitone is known to cause hypersensitivity reactions with benign pattern; ranging from a mild to moderate rashes but not life-threatening reactions such as TEN/SJS. Little is known about TEN in asthmatic patient. To the best of our knowledge, this is the first case of Phenobarbitone-induced TEN in a young asthmatic patient from the sub Saharan African. Case report: We report a 14-year-old right handed asthmatic male patient who presented with extensive blister skin eruptions involving the whole body including mouth ear canal later followed by skin exfoliation associated with low grade fever, sore throat, and dysphagia. The hypersensitivity skin reaction developed two weeks after initiation of Phenobarbitone of 100mg twice daily for a new onset generalized tonic clonic seizure. The exfoliation also involved oral and Conjunctival mucosa; with estimated 65% body surface area involvement; hence the diagnosis of Toxic epidermal necrosis was made. The Laboratory investigations were relevant for mild leucocytosis, prolonged prothrombin time, and reduced albumin. Phenobarbitone was discontinued and replaced with clonazepam; and the patient was managed with fluids replacement, IV antibiotics, twice daily wound care, analgesics, and naso gastric tube feeding. On subsequent days in intensive care unit (ICU), the patients’ clinical condition started improving; the skin lesion also started to heal and exfoliate in most of the affected skin surface areas, and the patient was discharges improved after ten days of ICU care.Conclusion: In summary, the present case describes, a 14-years-old young child with history of allergy in a form of asthma and new onset seizure disorder; and developed toxic epidermal necrosis following exposure to Phenobarbitone. This case also highlighted the benign prognosis observed in paediatrics population with TEN.

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Fatal case of toxic epidermal necrolysis induced by ciproflfl oxacin in a child

Our Dermatology Online ◽

10.7241/ourd.2021s1.6 ◽

2021 ◽

Vol 12 (Supp 1) ◽

pp. 26-29

Author(s):

Thomas Schiestel

Keyword(s):

Case Report ◽

Toxic Epidermal Necrolysis ◽

Adverse Reactions ◽

Pediatric Population ◽

Fatal Case ◽

Stevens Johnson Syndrome ◽

Delayed Treatment ◽

Drug Eruptions ◽

Johnson Syndrome ◽

Life Threatening

Bullous drug eruptions such as Toxic Epidermal Necrolysis (TEN) and Stevens-Johnson syndrome (SJS) are rare but known adverse reactions of fluoroquinolones. Although uncommon, TEN can be life-threatening for the patient, especially in the context of delayed treatment and in fragile patients such as the pediatric population. In the present case, TEN occurred in a 13-year-old girl with no medical history following initiation of ciprofloxacin treatment for an inguinal cyst. We hope that the case report will make interrogate the practices concerning the use of antibiotics, in particular fluoroquinolones in the context of an use not prescribed by the Marketing Authorization of the drug in children.

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The Use of Massage Therapy as a Nonpharmacological Approach to Relieve Postlaparoscopic Shoulder Pain: a Pediatric Case Report

International Journal of Therapeutic Massage & Bodywork Research Education & Practice ◽

10.3822/ijtmb.v13i2.485 ◽

2020 ◽

Vol 13 (2) ◽

pp. 45-49

Author(s):

Deborah Zerkle, LMT, Erin Gates, PT, DPT

Keyword(s):

Case Report ◽

Shoulder Pain ◽

Pediatric Population ◽

Massage Therapy ◽

Single Session ◽

Retrospective Case ◽

Pediatric Case ◽

Patient Reported ◽

Therapy Intervention ◽

Therapy Treatment

Introduction: Postlaparoscopic shoulder pain (PLSP) has been well documented to effect patients following an abdominal or thoracic laparoscopic surgery. PLSP is characterized by referred pain that can occur both unilaterally or bilaterally, and is typically caused by phrenic nerve irritation. Current literature has focused on pharmacological treatment; however, there is limited evidence for the use of nonpharmacological management of PLSP in the pediatric population. Case Description: This retrospective case report study explores the use of a single-session massage therapy treatment for a 17-year-old patient with PLSP following laparoscopic abdominal surgery. Intervention and Results: Therapy intervention included a 25 min Swedish massage involving the effected shoulder with an emphasis on passive touch to the shoulder and at the level of the diaphragm. Pain was assessed using the Visual Analog Scale (VAS) pre- and postintervention. Following therapy the patient reported 0/10 pain. Conclusion: This case report provides evidence for the use of massage therapy treatment as a noninvasive, nonpharmacological approach to reducing or eliminating PLSP in a pediatric patient.

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Phenytoin Induced Stevens Johnson Syndrome- Toxic Epidermal Necrolysis Overlap Exacerbated by Cephalexin in a 65-Year-Old Neurosurgical Patient: A Rare Case Report

Current Drug Research Reviews ◽

10.2174/2589977513666210322160009 ◽

2021 ◽

Vol 13 ◽

Author(s):

Kiran Kumar Rathinam ◽

Sarvesh Sabarathinam ◽

Poojith Nuthalapati ◽

Vijayakumar Thangavel Mahalingam

Keyword(s):

Case Report ◽

Rare Case ◽

Detailed Examination ◽

The Body ◽

Stevens Johnson Syndrome ◽

Communicating Hydrocephalus ◽

Drug Induced ◽

Johnson Syndrome ◽

Rare Case Report ◽

Epidermal Necrosis

Objective: To report a rare case of drug induced overlap of Stevens-Johnson syndrome and Toxic Epidermal Necrosis Syndrome exacerbated by cephalexin. Case summary: In this case report we present a 65-year-old female who had come to the hospital with complaints of Sloughing of the skin and redness all over the body with raised body temperature. She was on therapeutic Phenytoin to prevent the post-surgical complications of Communicating Hydrocephalus. After a detailed examination it was found that the patient had misemployed with an overdose of Phenytoin. The patient was found with nikolsky sign and diagnosed as Stevens-Johnson syndrome and Toxic Epidermal Necrosis overlap. This case report emphasizes phenytoin induced Stevens-Johnson syndrome and Toxic Epidermal Necrosis syndrome exacerbated by cephalexin. Practice implications: By witnessing this phenomenon, we could figure out the association between cephalexin and Stevens-Johnson syndrome- Toxic Epidermal Necrosis syndrome overlap. The Immediate dismissal of the offending agent and commencement of supportive care was found to be effective.

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Huge low-grade chondrosarcoma arising from rib cage: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20174542 ◽

2017 ◽

Vol 4 (10) ◽

pp. 3567

Author(s):

Manal M. Khan ◽

Yasmee Khan ◽

Rohit Kumar Namdev

Keyword(s):

Case Report ◽

Gall Bladder ◽

Low Grade ◽

Radiological Findings ◽

Rib Cage ◽

Present Patient ◽

Characteristic Appearance ◽

Early Stages ◽

Patient Reported

We report a case of 35 years old male who presented with a huge, gradually progressing swelling of right side of chest and abdomen for 5 years. Dimensions of swelling were 40cmx30cm. Radiological findings suggested characteristic appearance of a chondrosarcoma which was arising from right lower ribs. Lesion has involved whole liver, gall bladder, right half of colon and right kidney. On histopathology, we found low grade chondrosarcoma. Though low-grade chondrosarcoma is a potentially curable neoplasm in its early stages, the present patient reported very late. As famous dictum said “the ignorant are ignorant of their ignorance “, this is a classic example of patient's ignorance which converted a curable disease into incurable.

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Rhabdomyolysis: A Case Report of an Extrapulmonary Presentation of Mycoplasma pneumoniae

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2020.9.46024 ◽

2021 ◽

Vol 2 (5) ◽

pp. 194-197

Author(s):

Michael Gulenay ◽

V. Andres Sasson ◽

Kevin Taylor

Keyword(s):

Case Report ◽

Mycoplasma Pneumoniae ◽

Unusual Case ◽

Pediatric Population ◽

Subsequent Development ◽

Supplemental Oxygen ◽

Stevens Johnson Syndrome ◽

Upper Respiratory Infection ◽

Johnson Syndrome ◽

Upper Respiratory

Introduction: We present an unusual case of rhabdomyolysis secondary to Mycoplasma pneumoniae in a healthy 27-year-old female. M. pneumoniae is associated with numerous extrapulmonary manifestations, including acute hepatitis, Stevens-Johnson syndrome, and rhabdomyolysis. Most documented cases affect the pediatric population, with only five cases in adults reported in the literature. Case Report: The patient presented with complaints of myalgia and intractable cough. In this case the initial presentation demonstrated hypoxia requiring supplemental oxygen, and a creatine kinase of 7,646 units per liter (U/L) (reference range 26-192 U/L) with a peak of 29,427. During her hospitalization, she also remained persistently hypoxic for several days but ultimately was successfully weaned off all supplemental oxygen. She was discharged home after a seven-day hospitalization. Conclusion: This patient’s presentation of an insidious, upper respiratory infection along with the subsequent development of rhabdomyolysis with reactive antibodies to M. pneumoniae demonstrates a link between these two clinically important conditions.

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Sulfadiazine induced Stevens Johnson syndrome in toxoplasmosis patient: a case report

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20204108 ◽

2020 ◽

Vol 9 (10) ◽

pp. 1615

Author(s):

Sagar Raju ◽

Shilpa Shashidharan ◽

Rani M. Kurian ◽

Rima Ramla ◽

Arun Paingamkulangara

Keyword(s):

Case Report ◽

Health Care Professionals ◽

Adverse Reactions ◽

Case Reports ◽

Secondary Infection ◽

Stevens Johnson Syndrome ◽

Johnson Syndrome ◽

Indian Male ◽

Severe Skin Reaction ◽

Epidermal Necrosis

Stevens johnson syndrome is an acute, self-limited disease, presenting as severe mucosal erosions with widespread erythematous, cutaneous macules or atypical targets. Even though sulfadiazine has been mainly associated with haematological-related adverse effects, sulfadiazine induced skin necrosis has received less attention or went unrecognized. Here is a 29-year- old Indian male received T. Sulfadiazine 500mg 1-1-1-1 and experienced a severe skin reaction which was diagnosed as stevens johnson syndrome (SJS). The above drug will be implicated in cases of stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). There are few case reports of that have been associated with stevens johnson syndrome (SJS)/toxic epidermal necrosis (TEN). We hope that this case report creates awareness to the health care professionals. Clinicians must be aware of these adverse reactions and advise their patients to contact them as soon as they observe any unexpected clinical response. Early diagnosis helps the clinician to elude secondary infection and subsequent complications. The offending drug should be discontinued and never be rechallenged.

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