Ibuprofen
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Undifferentiated bullous rash leading to macrophage-activating syndrome and multi organ system dysfunction: case report A 14-year-old boy developed undifferentiated bullous rash leading to macrophage-activating syndrome (MAS) and multi organ system dysfunction following treatment with ibuprofen [therapeutic indication not stated]. The boy was hospitalised due to a rapidly progressive bullous rash. He visited to multiple outpatient providers due to an erythematous papular rash and received therapy with unspecified antihistamines and steroids without improvement. At the time of current admission, he had hypotension, fever and a rapidly progressive, painful, desquamating rash covering 70% of the body surface area (BSA) with no mucosal involvement. The boy received fluid resuscitation and unspecified broadspectrum antibacterials [antibiotics] due to concern for infectious aetiology. On hospital day 2, he developed shock, transaminitis, acute kidney injury and lactic acidosis, which required intubation, vasopressor and paralysis support. Additionally, he received debridement and wound care. Immune globulin was given for possible toxin-mediated process or atypical Stevens Johnson Syndrome (SJS). Biopsy finding was consistent with drug reaction or apoptotic panepodermolysis. It was noted that he had recent exposure to ibuprofen [route and dosage not stated], which raised concerns for atypical SJS/TEN. His pancytopenia and significant elevation of ferritin and SILR2 increased concerns for rheumatological or oncological disease. Further, bone marrow biopsy demonstrated haemophagocytosis possibly due to haemophagocytic lymphohistiocytosis/MAS. His infectious and oncological evaluations were negative. Thereafter, he started receiving anakinra. Based on the clinical picture, rheumatological disease including systemic lupus erythematous, juvenile idiopathic arthritis and Kawasaki disease were ruled out. Exact aetiology of the MAS was not identified, but he responded well to anakinra therapy [not all outcomes stated]. The undifferentiated rash possibly due to ibuprofen was considered, which resulted in multi organ system dysfunction and MAS with significant BSA involvement [duration of treatment to reactions onsets not stated]. Author comment: "In this case we presume the MAS was secondary to the severe desquamating rash that was possibly drug related." Vijayaraman A, et al. An unusual case of an undifferentiated bullous rash leading to macrophage-activating syndrome research snapshot theater: Neuroscience I. Critical Care Medicine 47 (Suppl. 1): 325 abstr. 690, No. 1, Jan 2019. Available from: URL: https://journals.lww.com/ccmjournal/ Citation/2019/01001/690__AN_UNUSUAL_CASE_OF_AN_UNDIFFERENTIATED.653.aspx 803431909 [abstract] - USA
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Reactions 9 Nov 2019 No. 1778
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