• PDF / 151,618 Bytes
• 1 Pages / 595.245 x 841.846 pts (A4) Page_size
• 102 Downloads / 138 Views

DOWNLOAD

REPORT

---

1 S

Stevens-Johnson-syndrome/toxic-epidermal-necrolysis and lack of efficacy: case report A 26-year-old man developed Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) during treatment with aciclovir for Herpes labialis infection. Later, he exhibited lack of efficacy while receiving ciclosporin for the SJS/TEN. The man presented to the emergency department with a 2 day history of fever and generalised rash. Prior to the presentation, he was diagnosed with Herpes labialis infection, and was prescribed a 7 day course of oral acyclovir [acyclovir] 400mg tablets three times a day. However, 1 day after the aciclovir therapy initiation, he developed fever, malaise, stinging in the eyes and pain on swallowing. Additionally, he developed tender skin lesions on the face, which extended to his back, trunk and extremities. After 5 days of therapy, cutaneous examinations showed dusky-red purpuric macules involving 25% of his body. Multiple flaccid blisters were noted with positive Asboe-Henson sign over the trunk and large areas of raw and bleeding dermis with positive pseudoNikolsky sign. Laboratory parameters showed elevated levels of creatinine and transaminases along with leucocytosis and thrombocytopenia. The analysis of severity of illness score for toxic epidermal necrolysis indicated a mortality risk of 35.8%. Causality assessment as per Naranjo Probability Scale and WHO-UMC scale indicated a probable and probable/likely causality, respectively. Based on the findings, he was diagnosed with aciclovir therapy induced SJS/TEN. The man’s aciclovir therapy was stopped. Unspecified supportive care along with oral ciclosporin [cyclosporine] 5 mg/kg were started as treatment. Despite the aggressive treatment, his condition continued to worsen and was complicated by acute kidney injury, acute respiratory distress syndrome and deteriorating GCS. Eventually on day 11, he died due to the SJS/TEN. Sen SS, et al. Stevens-Johnson syndrome-toxic epidermal necrolysis: a fatal cutaneous adverse reaction to oral acyclovir. BMJ Case Reports 13: no pagination, No. 8, 26 Aug 2020. Available from: URL: http://doi.org/10.1136/bcr-2020-238555 803502492

0114-9954/20/1823-0001/$14.95 Adis © 2020 Springer Nature Switzerland AG. All rights reserved

Reactions 26 Sep 2020 No. 1823