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Drug Eruption CS-OSPE

May 24, 20254 min read

Drug Eruption CS-OSPE

This is a back of a 50 Y/O patient who is on oral antibiotics.

Toxic Epidermal Necrolysis (TEN)

  • Describe the skin condition? Generalized erythema, detachment of the skin
  • What is the most likely diagnosis? Toxic epidermal necrolysis (because detachment of skin 30% or more)

  1. What is the positive clinical sign confirms the diagnosis? Nikolsky sign

    • More than 30% of skin is involved.
    • Mucus membrane involvement - Conjunctiva

  2. Differential Diagnosis:

    • Steven Johnson syndrome - DRESS
    • Pemphigus vulgaris - Bullous Pemphigoid

  • What is the management?

    • Admission
    • Antibiotic
    • Correct the fluids, electrolyte, and protein
    • Cover him for hypothermia
    • Treat the underlying cause

  • Discuss the consequences of this condition if not treated appropriately? Infection, cardiac and renal failure, septicemia

  1. What area of the body you should check next? Mucus membrane
    • Oral
    • Conjunctiva
    • Genital

Stevens-Johnson Syndrome (SJS)

  1. This child developed this manifestation after taking cephalosporin for chest infection, This is:

    • SJS
    • TEN

  2. Line of treatment:

    • Admit to ICU
    • Skin biopsy
    • Broad-spectrum antibiotics
    • Debridement
  • Lady came to ER and she was taking oral antibiotic; we noticed that there is redness in her body less than 3%. What is the diagnosis? SSSS / SJS
  • What is the positive sign? Nikolsky sign.

Positive Nikolsky’s Sign

Positive Nikolsky’s Sign Nikolsky Sign : Dislodging of epidermis by lateral finger pressure in the vicinity of lesions, which leads to an erosion. Shearing stresses on normal skin can cause new erosions to form

Erythema Multiforme

A 16 Y/O boy presents with a four-day history of oral erosions, eye pain, and cough. Exam reveals scattered targetoid plaques on the trunk (less than 3% body surface area) and superficial erosions on the lips and buccal mucosa with hemorrhagic crusting. widespread + oral Involvement

Girl with wheel appearance on her skin no more than 5h and oral involvement Dx?

  • Erythema multiforme.
  1. What is the most likely diagnosis? Erythema multiforme
  2. Which is the characteristic skin finding of this disease? Target lesion

Treatment?

  • Topical corticosteroid.

This patient took cephalexin for the second time and had the same reaction at the same site.

Fixed Drug Eruption

Tt:

  • Systemic + topical corticosteroids

Erythroderma

At midnight you have been called by the ER – resident to consult you about a 35 Y\O man who was brought in by his brother due to generalized redness of the body that almost involved all his body. His brother said that the condition started gradually last week and he got worse despite copious amounts of emollients he used in the last few days. His brother told you two weeks before he developed this condition, he received a short course of oral Prednisolone (steroid) prescribed by a chest physician due to chest allergy. When you examined him, he was shivering. With a lot of scales on his body and you noticed small, two thick, well-demarcated plaques on his elbows, he said they were here for six months. The vital signs are as follow: BP 115/65 mmHg, pulse 70 bpm, body temp 37.5c

  • Referring to the above scenario what is the emergency condition developed? Erythroderma

  • What is the diagnosis? Erythroderma

  • Mention three dermatological diseases may complicated by this condition? Psoriasis, chronic dermatitis, drug eruption, leukemia, lymphoma

  • What are the consequences of this condition? Hypothermia, high cardiac output failure, hypoalbuminemia, hyperkalemia

  • What is the management?

    • Burn Care unit**
    • Admission.
    • Antibiotic
    • Correct the fluids, electrolyte, and protein
    • Cover him for hypothermia
    • Treat the underlying cause

DRESS Syndrome Case

Case Scenario

A 34-year-old male known case of epilepsy for the past two years came to you suffering from high grade fever and some skin rash all over his body for the last 4 days. Patient mentioned that 2 weeks ago he had an episode of seizure so he took an anticonvulsant drug “phenobarbital”. On examination you find a papule and pustule in his trunk. Eosinophil was 2000mcl.

  1. What is your diagnosis? Dress syndrome
  2. What is the cause from the scenario? Ingestion of phenobarbital 2 weeks ago
  3. Mention 4 evidence from the history that support your diagnosis? Arrange it from the most imp. to least imp.
  4. How to manage your patient?

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