Multiple drugs
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Multiple drugs Fatal Stevens-Johnson syndrome, fatal toxic epidermal necrolysis and lack of efficacy: 3 case reports
In a case report of patients, who presented to a centre in China, 3 patients including 2 boys and 1 girl (aged 2–6 years) were described, who developed fatal Stevens-Johnson syndrome (SJS)/ toxic epidermal necrolysis (TEN) overlap, SJS or TEN during treatment with cefazolin, unspecified for nonsteroidal-anti-inflammatories or cefotaxime. Additionally, 2 patients exhibited a lack of efficacy during antibacterial treatment with tigecycline, imipenem/cilastatin, metronidazole, meropenem, vancomycin or amikacin or antifungal therapy with itraconazole or voriconazole for infections [route, dosages and times to reactions onsets not stated]. Patient 1: The 2-year-old boy, who was admitted to a hospital in China with a mild fever and blurred vision for 1 week (unspecified infection), He received antibacterial therapy with cefazolin, leading to recovery. He was subsequently diagnosed with skull base neoplasms with bone metastasis. He underwent a biopsy, which showed neuroblastoma. His body temperature did not improve, and on the day 14 from the onset of illness, he developed erythematous papules, skin erosions, bullae on the face, genitalia, neck and trunk that covered ~15% of the body surface area (BSA). Following dermatologic consultations, a diagnosis of SJS/TEN was made. Therefore, he started receiving immunoglobulin [immune-globulin] and methylprednisolone. He exhibited an involvement of a larger area of the skin (~25% BSA) within following 6 days. Then, he was moved to the paediatric ICU (PICU) due to haematemesis, respiratory distress and severe unspecified infection on the day 22 from the onset. On PICU admission, he started receiving high-flow oxygen, and the skin lesions, which covered ~25% of the BSA, were observed on physical examination. Also, abdominal distension and hyperactive bowel sounds were noted, and distal extremities were found to be notably cool. Blood test results abnormal WBC, haemoglobin level and platelet count. Based on the confirmed diagnosis of SJS/TEN along with complication of septic shock and respiratory failure, he started receiving meropenem and vancomycin (multi-antibacterial therapy) along with aggressive support treatments. It was noted that he developed septic shock likely due to the impaired mucosal barrier from denuded skin. The WBC, haemoglobin count and platelet count normalised; however, he experienced rapid progressive deterioration, with persistently high CRP and PCT levels. Pathogens were not detected in the blood and sputum cultures. However, 6 days after the PICU admission, he died because of septic shock caused by out-of-control severe infections and SJS/TEN on the day 28 from the onset. It was noted that he developed fatal SJS/TEN overlap secondary to cefazolin. Additionally, the skull base neoplasms and unspecified infection prior to cefazolin use were also considered to have triggered the SJS/TEN. Patient 2: The 6-year-old boy, who received unspecifi
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