Mahto Vidya, Thapa Meena, Padhye Saraswoti
Department of Obstetrics and Gynecology, Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2019 Sep-Oct;57(219):382-384. doi: 10.31729/jnma.4638.
Toxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death. This is the first case report in Nepal of toxic epidermal necrolysis in puerperium. We present a case of a 28-years-old, P1L1 on fourth postoperative day following emergency lower segment caesarean section for cephalopelvic disproportion in latent phase of labour with uneventful antenatal period. She developed fever followed by rashes all over the body with hypotension, tachypnea and shortness of breath. Initially, she was diagnosed as a case of septic shock and transferred to intensive care unit from postnatal ward. She was managed with broad spectrum antibiotics and inotropes. Later on, it was found to be the case of Toxic epidermal necrolysis and managed with vancomycin and corticosteroids under the supervision of gynecology, dermatology and medicine team. Keywords: puerperium; toxic epidermal necrolysis; vancomycin.
中毒性表皮坏死松解症是一种潜在的危及生命的皮肤病，其特征为广泛的红斑、坏死和水疱，表皮和黏膜剥脱导致皮肤脱落，可能发生败血症甚至死亡。这是尼泊尔首例关于产褥期中毒性表皮坏死松解症的病例报告。我们报告一例28岁经产妇，孕1产1，因潜伏期头盆不称行急诊低位剖宫产术后第4天，孕期平顺。她出现发热，随后全身出现皮疹，伴有低血压、呼吸急促和呼吸困难。最初，她被诊断为感染性休克，从产后病房转入重症监护病房。给予广谱抗生素和血管活性药物治疗。后来发现是中毒性表皮坏死松解症，在妇科、皮肤科和内科团队的监督下，用万古霉素和皮质类固醇进行治疗。关键词：产褥期；中毒性表皮坏死松解症；万古霉素
