scholarly journals Steven johnson syndrome induce by carbamazepine in epileptic patient: a case report

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Nyoman Yoga Maya Pramita ◽  
Prima Saraswati Sanjiwani Sudarsa ◽  
Ratih Purnamasari Nukana
Keyword(s):  
Epileptic Patient ◽  
Case Series ◽  
Johnson Syndrome ◽  
Chief Complaints ◽  
Upper And Lower Extremities ◽  
Life Threatening ◽  
History Of ◽  
Appropriate Therapy ◽  
Steven Johnson Syndrome

Introduction: Steven Johnson Syndrome (SJS) is life-threatening skin reaction, it is a mucocutaneous disorder induced by immune complex-mediated hypersensitivity reaction. Most frequent offending agents are antibiotic, antiretroviral and aromatic anticonvulsants. Problems arise when these drugs are required for long-term use and necessary for several health conditions. These case series aim to describe SJS and provide replacement therapy especially inpatient with epilepsy.Case report: A 37 years old female was consulted from neurology department with chief complaints an erythematous rash on her chest, back upper and lower extremities accompanied with fever, the patient also complaint erosions on her lips. She had history of seizure and was prescribe Carbamazepine. Carbamazepine was replaced and patient treated with dexamethasone intravenously. After 1 week of admitted there is an improvement.Conclusion: Steven Johnson Syndrome (SJS) is a life-threatening disease, the replacement of the suspected drugs and appropriate therapy can improve the prognosis of patient. 

scholarly journals A Case Report of Steven Johnson Syndrome

2021 ◽  
pp. 132-139
Author(s):  
Archana Dhengare ◽  
Ranjana Sharma ◽  
Sonali Waware ◽  
Pranali Wagh
Keyword(s):  
Stevens Johnson Syndrome ◽  
Skin Allograft ◽  
Case Presentation ◽  
Johnson Syndrome ◽  
Chief Complaints ◽  
Long Time ◽  
History Of ◽  
Long Term Consequences ◽  
Steven Johnson Syndrome

Introduction: In 1922, two doctors, Albert Mason Stevens and Frank Johnson, examined purulent conjunctivitis.” Background: Stevens-Johnson syndrome was named after them as a result of their study. The incidence rate is 7 cases per million populations per year. Case Presentation: Master Yash Ghudam was brought to AVBRH by his parents with chief complaints of fever since 5 days and erythematous lesions all over body since 3 days. History of present illness: Patient was apparently alright 5 days back, and then he started having fever which was of high grade and was not associated with chills and rigor. Patient was treated on OPD basis and the symptoms of an unexplained disease in two young boys, aged 7 and 8, who had "an unusual, generalised eruption of continued fever, inflamed buccal mucosa, and extreme some antibiotic was given, but there was no relief, after 2 days there was ulcers formation inside the mouth for which some ointment and syrup becosule was started. But lesions were increasing. 3 days back the lesions first appeared on chest then got spread to legs and hands. For which patient was admitted in Chandrapur hospital from were the patient was referred to AVBRH for further management. Interventions: The patient was treated the patient was started on intravenous and orally Cortecosteroids, Omnacortil 10mg, Antibiotics- Inj. Ceftriaxone1gm IV 12 hourly [100mg/kg/day], inj. Amikacin 150mg IV 12 hourly [15mg/kg/day], Syp. Mucaine gel 2tsp BD – swish and swallow), Syp. Cital  2.5ml TDS, Tab. Chymoral Forte  TDS, Inj. Pantop 20mg IV 24 hourly (1mg/kg/dose). Pandya’s Formula: Syp. Gelusil 5ml, Syp. Benadryl 5ml, Syp. Omnacortil 5ml.  Skin allograft: It has been planned. Conclusion: In this study, we mainly focus on medical management and outstanding nursing care helped prevent farther complication. Overall, the patient's reaction was positive, though recovery time from Steven johnson syndrome varies from person to person, taking weeks, months, or even years. However, only a small number of people completely recover, while some have long-term consequences. She took a long time to get back on her feet.

scholarly journals Stevens-Johnson Syndrome in a Child on Phenytoin, Exacerbated with Cefixime

2019 ◽  
Vol 39 (3) ◽  
pp. 193-196 ◽  
Author(s):  
Yam Bahadur Roka ◽  
Sabrina Shrestha ◽  
Narayani Roka ◽  
Mohan Karki
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Whole Body ◽  
Stevens Johnson Syndrome ◽  
Intravenous Fluids ◽  
Oral Ulceration ◽  
Topical Antibiotics ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
History Of ◽  
Steven Johnson Syndrome

Steven Johnson syndrome and toxic epidermal necrolysis are rare but potentially life threatening muco-cutaneous disorders. Their incidence ranges from 1.2 to six per million patient-years for Steven Johnson syndrome and 0.4 to 1.2 per million patient-years for toxic epidermal necrolysis. Drugs are the primary cause for these syndromes in majority cases. They might also be due to infections with Mycoplasma Pneumoniae or Herpes Simplex. The mortality ranges from five to 40% in these cases. We report a 10-year old girl who presented with history of multiple skin eruptions involving whole body and oral ulceration for five days. She was a known case of seizure disorder on phenytoin and had been prescribed Cefexime for fever. She was managed with intravenous fluids, corticosteroids, opiates, antacids and topical antibiotics. We want to highlight the possibility of Steven Johnson syndrome following the combination of these two drugs.

scholarly journals Profile And Treatment Steven Johnson Syndrome Patients In Inpatient Kemuning I And II RSUD DR. Soetomo Period 2011-2015

2019 ◽  
Vol 4 (2) ◽  
pp. 32
Author(s):  
Anggun Tera Rahmasari
Keyword(s):  
Medical Records ◽  
Secondary Data ◽  
Clinical History ◽  
Duration Of Treatment ◽  
Johnson Syndrome ◽  
Systemic Treatments ◽  
Life Threatening ◽  
History Of ◽  
Medical Histories ◽  
Steven Johnson Syndrome

Background: Steven Johnson Syndrome (SJS) is uncommon but potentially life threatening disease. SJS is Severe Cutaneous Adverse Reaction (SCAR). SJS is mostly caused by drugs and related with morbidity and mortality. Some researches have been published, but there was no standard for SJS’ treatment. The aim of this study is to present epidemiological features, aetiologies, clinical outcomes, medical histories, and treatments of SJS in Inpatient Unit Kemuning I and II RSUD Dr. Soetomo 2011-2015.Methods: This research used retrospective study which use secondary data collected from medical records. All of patients in Inpatient Kemuning I and II RSUD Dr. Soetomo from year 2011-2015 who diagnosed SJS were included in this research.Result: There were 29 medical records and consist of 23 woman and 6 man with the diagnosis of SJS found in 2011-2015. Most patients aged 25-44 years old. Most clinical history was fever. Drug which is expected to be the most cause of SJS is amoxicillin. There was no family history of SJS in all patients. Mucosa that was involved the most was eyes and mouth. Systemic treatments for patients were corticosteroid. The average duration of treatment was 15,88 day. None of the patients died.Conclusion: Females were more than males. The main systemic therapy in Inpatient Kemuning I dan II RSUD Dr. Soetomo is intravenous cortiosteroid and no patients died.

scholarly journals Systematic review of clinical outcomes after prophylactic surgery

2016 ◽  
Vol 98 (6) ◽  
pp. 353-357 ◽  
Author(s):  
CR Davis ◽  
AEJ Trevatt ◽  
A Dixit ◽  
V Datta
Keyword(s):  
Systematic Review ◽  
Acute Appendicitis ◽  
Prophylactic Surgery ◽  
Cochrane Central Register ◽  
Short Term ◽  
Asymptomatic Patients ◽  
Central Register ◽  
Life Threatening ◽  
History Of

Introduction Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acute appendicitis in the field. However, the risk–benefit ratio of prophylactic surgery is controversial. This study aimed to systematically review the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgery resulting in life-threatening complications. Methods A systematic review was performed using MEDLINE® and the Cochrane Central Register of Controlled Trials. Keyword variants of ‘prophylaxis’ and ‘appendicectomy’ were combined to identify potential papers for inclusion. Papers related to prophylactic appendicectomy risks and benefits were reviewed. Results Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes after incidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomy in asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylactic appendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios such as polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations. Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when the short-term risk of acute appendicitis outweighs the long-term risks of surgery. Conclusions Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence of long-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis by balancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgical procedure in a healthy patient.

scholarly journals Meropenem-induced Stevens-Johnson syndrome/toxic epidermal necrolysis in a patient with known type IV penicillin hypersensitivity

2019 ◽  
Vol 12 (8) ◽  
pp. e230144 ◽  
Author(s):  
Muhammad Sameed ◽  
Christine Nwaiser ◽  
Prashant Bhandari ◽  
Sarah A Schmalzle
Keyword(s):  
Toxic Epidermal Necrolysis ◽  
Cross Reactivity ◽  
Delayed Hypersensitivity ◽  
Stevens Johnson Syndrome ◽  
Hypersensitivity Reactions ◽  
Beta Lactam ◽  
Type Iv ◽  
Johnson Syndrome ◽  
Life Threatening ◽  
History Of

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are considered variants of a disease continuum that results in a life-threatening exfoliative mucocutaneous disease. These are categorised as type IV cell-mediated delayed hypersensitivity reactions, and antibiotics are often implicated as a cause. Penicillins and other beta-lactam antibiotics are known to cause both immediate and delayed hypersensitivity reactions. While immediate IgE-mediated cross-reactivity between penicillins and carbapenems is well studied, less information on the risk of type IV delayed cell-mediated cross-reactivity between the two is available. We present a case of meropenem-induced SJS in a patient with documented history of SJS from amoxicillin. There are few cases of cross-reactivity with carbapenems reported in the literature, but based on the potential for life-threatening reaction, it is likely prudent to avoid the use of any beta-lactams in a patient with a history of SJS, TEN or any other severe cutaneous adverse reactions to another beta-lactam antibiotic.

scholarly journals The “Fountain of Death”: A Case Series on Tracheo-innominate Artery Fistula

2021 ◽  
Vol 20 (2) ◽  
Author(s):  
Jason Lo ◽  
Marina Mat Baki ◽  
Yeoh Xing Yi ◽  
Nik Hisyam Amirul ◽  
Zahirrudin Zakaria
Keyword(s):  
Potential Role ◽  
Rare Complication ◽  
Case Series ◽  
Innominate Artery ◽  
Survival Outcomes ◽  
Permissive Hypotension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion

Tracheo-innominate artery fistula (TIF) is a very rare complication related to tracheostomy and has been reported in 0.7% of patients, but certainly is one of the most life-threatening conditions. It is of paramount importance to maintain a high index of suspicion in evaluating patients with TIF and to anticipate occurrence of massive haemorrhage even during simple procedures related to tracheostomy such as tube change. We report 3 cases of TIF, each with a unique and unsuspecting history of the condition and review the emergency protocol in arresting the bleeding. We’ve also highlighted the potential role of permissive hypotension with sedation in improving survival outcomes of patients with TIF.

scholarly journals SAT-579 Experiences with Hypertriglyceridemic Pancreatitis: A Mini Case Series

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Priyanka Majety ◽  
Richard D Siegel
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Early Recognition ◽  
Rare Complication ◽  
Case Series ◽  
Diagnostic Challenge ◽  
Eruptive Xanthomas ◽  
History Of ◽  
Appropriate Therapy ◽  
Pruritic Skin

Abstract Background: Hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP) in up to 14% of all cases & up to 56% cases during pregnancy. The triad of HTG, Diabetic ketoacidosis (DKA) and AP is rarely seen posing diagnostic challenges. Early recognition of HTG-induced pancreatitis (HTGP) is important to provide appropriate therapy & prevent recurrence. In this case series, we discuss the diagnostic challenges and clinical features of HTGP. Clinical cases: Our first patient was a 65-year-old male with a history of hypertension who presented to the ER with abdominal pain and new-onset pruritic skin rash after a heavy meal. His exam and labs were notable for a diffuse papular rash on his back, triglycerides (TG) of 7073mg/dL (normal: <150mg/dL). The rash improved with the resolution of HTG. Our second patient was a 29-year-old male with a history of alcohol dependence who was found to have AP complicated by ARDS requiring intubation. Further testing revealed that his TG was 12,862mg/dL & his sodium (Na) was 102mEq/L. Although HTG was known to cause pseudohyponatremia, it was a diagnostic challenge to estimate the true Na level. In a third scenario, a 28-year-old female with a history of T2DM on Insulin presented with nausea & abdominal pain. Labs were suggestive of DKA and lipase was normal. CT abdomen showed changes consistent with AP. The TG level that was later added on was elevated to 4413mg/dL. She was treated with insulin that improved her TG level. Discussion: We present three cases of hypertriglyceridemic pancreatitis. While the presentation can be similar to other causes of acute pancreatitis (AP), there are factors in the diagnosis and management of HTGP that are important to understand. Occasionally, physical exam findings can be suggestive of underlying HTG. In the first scenario, our patient presented with eruptive xanthomas - a sudden eruption of crops of papules that can be pruritic. They are highly suggestive of HTG, often associated with serum TG levels > 1500mg/dL. Our second patient presented with pseudohyponatremia. HTG falsely lowers Na level, by affecting the percentage of water in plasma. Identifying this condition is important to prevent possible complications from aggressive treatment. This can be corrected either by using direct ion-specific electrodes or with the formula: Na change = TG * 0.002. DKA is associated with mild-moderate HTG in 30–50% cases. This is due to insulin deficiency causing activation of lipolysis in adipocytes & decreased activity of lipoprotein lipase (LPL). However, severe HTG is a rare complication of DKA, increasing the risk of AP. Diagnosis of AP in DKA poses many challenges: the common presenting complaint of abdominal pain, non-specific hyperlipasemia in DKA. AP with DKA has also been associated with normal lipase levels. A high clinical index of suspicion is required to diagnose HTGP in patients with DKA.

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