Viswanath B K, Ranka P, Ramanjanayalu M
Department of Dermatology and J J M Medical College.
Indian J Lepr. 2012 Jul-Sep;84(3):227-32.
Severe Cutaneous Adverse Reaction (SCAR) represents the spectrum of adverse drug reactions from erythema multiforme, Stevens - Johnson syndrome (SJS) to Toxic Epidermal Necrolysis (TEN). A 55 year old lady presented in a toxic state with peeling of skin, blisters on the body of seven days duration following medications taken for fever and pulmonary tuberculosis. When referred to our institution, she was diagnosed as TEN. Immediately the suspected medications were stopped. The essential investigations were done including the screening for immunosuppression, which was found to be negative. The patient was treated symptomatically with emphasis on skilled nursing care. The patient's skin condition improved gradually but tuberculosis progressively worsened over three months. Thus patient was reinvestigated for seropositivity and was found to be positive. Considering the benefit - risk ratio along with the advice of the pulmonologist, a decision was made to give her a rechallenge test, first for antitubercular drugs and later for antipyretics. The patient developed SJS within two days of starting isoniazid (INH). On withdrawal of INH the patient recovered.
严重皮肤不良反应（SCAR）涵盖了从多形红斑、史蒂文斯-约翰逊综合征（SJS）到中毒性表皮坏死松解症（TEN）的一系列药物不良反应。一名55岁女性因发热和肺结核服药后，出现中毒症状，皮肤剥落、身上起水泡，持续了七天。转诊至我院时，她被诊断为TEN。立即停用了可疑药物。进行了必要的检查，包括免疫抑制筛查，结果为阴性。对患者进行了对症治疗，并重点给予了专业的护理。患者的皮肤状况逐渐改善，但肺结核在三个月内逐渐恶化。因此，对患者再次进行血清学阳性检查，结果呈阳性。综合考虑获益-风险比，并听取肺科医生的建议，决定对她进行再激发试验，首先针对抗结核药物，随后针对退烧药。患者在开始服用异烟肼（INH）两天内出现了SJS。停用INH后，患者康复。
