Corticosteroids/prednisolone acetate
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Facial swelling, striae and delayed healing: case report A 9-year-old boy developed facial swelling, striae and delayed healing of mucosal lesions following treatment with prednisolone acetate and unspecified systemic corticosteroids for ocular ulceration and corneal abrasion secondary to Mycoplasma-induced rash and mucositis [not all dosages stated; times to reactions onsets not stated]. The boy presented to hospital with fever, cough, inadequate oral intake, malaise and moderate dehydration for 5 days. Subsequent analyses led to the diagnoses of mycoplasmal pneumonia and M. pneumoniae-induced rash and mucositis. Hence, he started receiving unspecified systemic corticosteroids 1 mg/kg. Total parenteral nutrition (TPN) was initiated. He received azithromycin 5 mg/kg once daily for 5 days and ceftriaxone 50 mg/kg BID for 7 days for pneumonia. He also received prednisolone acetate 1% eye drops, erythromycin and left eye patching for ocular ulceration and a corneal abrasion, apart from supportive care. He exhibited remarkable improvement of cutaneous palm and sole bullae on hospital day 9 (day 8 of steroids); however, the mucositis of lips and urethra continued to form new lesions. Hence, it was decided to extend the course of steroids another week. Later, on admission day 16, after over 2 weeks of systemic corticosteroid therapy and completion of courses of azithromycin and ceftriaxone without significant improvement in his mucositis and cutaneous lesions, a trial of immune globulin was decided, which resulted in significant improvement of the mucositis within 2 days. Hence, it was believed that the use of steroids delayed healing of his mucosal lesions. He was weaned to oral nutrition after 27 days of TPN. He was discharged on hospital day 29. During 2-month follow-up, his recovery was complicated by facial swelling and striae due to steroid use. The boy’s steroid therapy was tapered, resulting in resolution of his facial swelling and striae. Rollins PD, et al. Severe Mycoplasma-Induced Rash and Mucositis Treated With IVIG. Clinical Pediatrics 59: 1097-1100, No. 12, Oct 2020. Available from: URL: http:// 803500961 doi.org/10.1177/0009922820931802
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Reactions 12 Sep 2020 No. 1821
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