Reactions 1680, p30 - 2 Dec 2017 Stevens Johnson-syndrome: case report A 73-year-old woman developed Stevens Johnson syndrome following treatment with amoxicillin. The woman was diagnosed with upper gastrointestinal bleeding and peptic-ulcer in May 2015. She received anti- Helicobacter pylori treatment with oral amoxicillin [dosage and duration of treatment to reaction onset not stated], pantoprazole, clarithromycin and colloidal bismuth pectin. She presented with an itchy erythema around her neck. On admission, oedematous erythema was observed on the face, head and neck. Her eyelids were slightly swollen. She had also been receiving unspecified anti-hypertensive tablets for hypertension. Laboratory tests revealed a neutrophil ratio of 74%, eosinophil ratio of 5.2%, ketone greater than 2 mmol/L, D-dimer 1.23mg/L. Following admission, her rash on the trunk, neck, limbs and face had worsened and she also experienced itchiness. She had fever, and the peripheral blood leucocytes were elevated. The drug eruption area and severity index (DASI) score was 9.9 points. The woman received treatment with compound glycyrrhizin and calamine lotion. However, her rash further integrated and worsened. The conjunctiva showed hyperaemia and the conjunctival secretions increased. Her face was swollen. She presented with fever at 6:00am on day 3 following the admission. The rash had integrated further with increased swelling and redness. She had difficulty in opening her eyes, and the conjunctival secretions increased further. Typical target-like erythematous papules developed on lower limbs. On day 4, her condition worsened. The rash aggravated and covered 80% of the body surface area. Her skin temperature increased. Her rash became severe. The body temperature was 39.6°C at 6:00pm. Marked increase in the leucocyte and neutrophil count was observed. She was diagnosed with Stevens Johnson syndrome. She then received treatment with etanercept. The rash and fever were under control. The conjunctival erosion was almost recovered. Her swelling decreased and the rash became less itchy. She was discharged on day 16 following complete recovery. The DASI score at discharge was 0.4 points. Author comment: "According to the probability of drug eruption, amoxicillin allergy was the most probable cause." "Parts of the rash were target-like and therefore, the diagnosis was severe erythema multiforme-type drug eruption (Stevens- Johnson syndrome)." Ling X, et al. Severe erythema multiforme-type drug eruption controlled by tumor necrosis factor-alpha antagonist: A case study. Experimental and Therapeutic Medicine 14: 5727-5732, No. 6, Dec 2017. Available from: URL: https:// doi.org/10.3892/etm.2017.5336 - China 803285638 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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