Kathmandu Medical College, Sinamagal, Kathmandu, Nepal.
Department of Internal Medicine, Kathmandu Medical College, Sinamagal, Kathmandu, Nepal.
JNMA J Nepal Med Assoc. 2020 Sep 27;58(229):702-704. doi: 10.31729/jnma.4999.
Steven Johnson syndrome and toxic epidermal necrolysis are severe and rare adverse drug reactions usually caused by drugs like antiepileptics, penicillin and allopurinol and sometimes also due to infections, malignancy or idiopathic in some cases. Here we are reporting a case of a 50 years female who came with complaint of a burning sensation on the upper half of the body with atypical flat target lesion that later coalesced involving her face, chest and bilateral upper limbs. On examination, positive nikolsky sign and tenderness with <10% body surface area involvement was noticed. The diagnosis of cotrimoxazole induced Steven Johnson syndrome was made. Patient was shifted to ICU and given supportive care along with prophylactic teicoplanin, itraconazole and dexamethasone. The mechanism of eruptions in our patient was due to cotrimoxazole. Cotrimoxazole induced Steven Johnson syndrome is rare and the supportive management with broad spectrum antibiotic and the corticosteroid was enough to beat this life-threatening condition. Keywords: cotrimoxazole; pneumonia; Steven Johnson syndrome.
史蒂文斯-约翰逊综合征和中毒性表皮坏死松解症是严重且罕见的药物不良反应,通常由抗癫痫药、青霉素和别嘌呤醇等药物引起,在某些情况下也可能由感染、恶性肿瘤或特发性因素引起。本文报告了 1 例 50 岁女性患者,其主要表现为上半身烧灼感,伴有非典型的扁平靶形皮损,皮损逐渐融合累及面部、胸部和双侧上肢。体格检查发现尼氏征阳性,触痛,受累面积<10%。诊断为复方磺胺甲噁唑诱导的史蒂文斯-约翰逊综合征。患者转入重症监护病房,给予支持治疗,同时预防性使用替考拉宁、伊曲康唑和地塞米松。患者的皮疹机制是由于复方磺胺甲噁唑。复方磺胺甲噁唑诱导的史蒂文斯-约翰逊综合征较为罕见,采用广谱抗生素联合皮质类固醇的支持治疗足以控制这种危及生命的情况。关键词:复方磺胺甲噁唑;肺炎;史蒂文斯-约翰逊综合征。