Diclofenac
- PDF / 170,543 Bytes
- 1 Pages / 595.245 x 841.846 pts (A4) Page_size
- 38 Downloads / 181 Views
1 S
Toxic epidermal necrolysis following off label use: case report A 32-months-old girl developed toxic epidermal necrolysis following off label administration of diclofenac for fever associated with upper respiratory tract infection. The girl, who was presented with weakness, generalised macular erythematous cutaneous rashes on the trunk, genitals, extremities and face with bleeding lesions on the mouth and lips, redness of the eye and conjunctivitis, was admitted to hospital. Clinical examination revealed numerous small blisters on her trunk. Her anamnesis revealed history of upper respiratory tract infection and single dose off-label administration of a diclofenac [dosage not stated] suppository for fever prior to admission. At the time of admission, she was afebrile and had stable vital signs. Within two days, the lesions had rapidly progressed to necrosis and spread more than 70% of the body [time to reaction onset not stated]. The girl was transferred to the paediatric intensive care unit (PICU) and received wavy mattress and sterile sheets. Fluid therapy was initiated along with immunoglobulin [IVIG] followed by hydrocortisone. Sterile vaseline gauze were used for covering the cutaneous lesions. Glycerin and lidocaine were used for painful lesions of the genital areas and mouth. The ophthalmologist recommended artificial tears repeatedly administered with erythromycin and liposic gel. A central venous catheterisation was placed due to extension and severity of the lesions. In the first week of admission due to the impossibility of oral nutrition, she started receiving total parental nutrition. Pantoprazole was also administered to prevent stress ulcer. Oral nutrition was initiated gradually from the sixth day and further slowly increased daily. During the second week, she had fever with elevated CRP and ESR. Blood samples test and urine culture was performed. She received empirical therapy with various broad spectrum antibacterials. Afterwards, the cultures came back negative. The fever resolved within a few days. Total parental nutrition was discontinued on day 18. On day 20, the general condition improved with cessation of appearance of new lesions. On day 21, she was transferred to the ward, and was discharged in good condition on day 29. At that time, it was noted that the lesions were dry and healing. Aghdam MK, et al. Toxic epidermal necrolysis syndrome following single-dose diclofenac suppository, A case report. Journal of Comprehensive Pediatrics 11: no pagination, 803496963 No. 2, 24 Mar 2020. Available from: URL: http://doi.org/10.5812/compreped.100496
0114-9954/20/1818-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved
Reactions 22 Aug 2020 No. 1818
Data Loading...
