Ali Junaid, Rahman Mansoor, Ahmad Ammar, Khattak Zoia, Shahzad Muhammad Asim
Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.
Internal Medicine, Lady Reading Hospital MTI, Peshawar, PAK.
Cureus. 2021 Aug 11;13(8):e17101. doi: 10.7759/cureus.17101. eCollection 2021 Aug.
Hypersensitivity reactions occur when a host exhibits an inappropriate or exaggerated response to allergens. Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of such exaggerated responses to various drugs or illnesses. Both conditions affect the skin and mucosal surfaces of the oral cavity, urethra, and conjunctiva to varying degrees. TEN involves more than 30% of the total body surface area as opposed to SJS with less than 10% involvement. Skin biopsy is considered the gold standard for diagnosis; however, obtaining appropriate clinical context at presentation with the history of a potential offending drug can help diagnose the condition in situations where skin biopsy is not feasible. Metronidazole has been rarely reported as the offending agent for TEN/SJS with only two previously reported cases in the literature. We present the third case of TEN secondary to metronidazole and discuss the potential mechanism of action of metronidazole along with its common side effects. Our case adds to the existing literature of this rare clinical presentation and highlights the importance of the judicious use of metronidazole in clinical practice.
当宿主对过敏原表现出不适当或过度的反应时，就会发生超敏反应。史蒂文斯-约翰逊综合征（SJS）和中毒性表皮坏死松解症（TEN）就是对各种药物或疾病的这种过度反应的例子。这两种病症都会不同程度地影响皮肤以及口腔、尿道和结膜的黏膜表面。TEN累及全身表面积的30%以上，而SJS累及不到10%。皮肤活检被认为是诊断的金标准；然而，在呈现潜在致病药物病史的情况下获得适当的临床背景，有助于在无法进行皮肤活检的情况下诊断病情。甲硝唑很少被报道为TEN/SJS的致病药物，文献中此前仅报道过两例。我们报告了第三例继发于甲硝唑的TEN病例，并讨论了甲硝唑的潜在作用机制及其常见副作用。我们的病例补充了这种罕见临床表现的现有文献，并强调了在临床实践中谨慎使用甲硝唑的重要性。
