Search

Metformin is one of the most widely prescribed medications for type 2 diabetes. While extremely rare, metformin has been reported to cause hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency. In this paper, we present a case of a patient with previously undiagnosed glucose-6-phosphate dehydrogenase deficiency who presented with hemolysis likely induced by metformin. The patient concurrently presented with idiopathic Steven-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). Metformin causing hemolysis is extremely rare but considering the severe outcomes, it is something that medical practitioners need to be aware of.

Steven-Johnson syndrome (SJS) is a rare medical emergency that is characterized by widespread skin and mucosal lesions. Oral mucosal involvement is seen in 90% of SJS and it is often widespread and confluent. In the majority of the cases, the symptoms are associated with an adverse drug reaction, usually to non-steroidal anti-inflammatory drugs, sulfonamides, anti-epileptics, or antibiotics. Recently, SJS associated with herbal medicine has been reported. This paper aims to report 3 cases of SJS with marked oral manifestations, following the use of local herbal medicine, diagnosed in a children´s hospital in Nigeria within a year. Three children aged 1.5, 9 and 10 years presented in our emergency unit with features of SJS, history of the use of local herbal medicine to cure an ailment was elicited in all cases before admission into our hospital. All the cases presented with cutaneous exfoliating exanthema and bullous eruptions with oral mucosa appearing as painful crusted erythematous lesions. One of the 3 cases, a male patient, presented clinically with septicaemia complicated with anaemia as well as nasal involvement. Discontinuation of herbal medicine in all cases resulted in a relief of symptoms. A multidisciplinary approach of management was instituted with resultant total recovery of patients. This case report addresses the fact that severe hypersensitivity reactions can occur with the use of herbal medicine. Emphasis should be on active vigilance in the use of herbal medicine.

The authors present a case of a 54-year-old male who presented to the ED with Stevens Johnson syndrome (SJS) beginning on his upper lips, then spreading to his glans penis, airway, and buttocks. After using trimethoprim-sulfamethoxazole (TMP-SMX) to treat a pilonidal cyst diagnosed seven days prior to presentation, the patient began to have desquamating lesions on his upper and lower lips. Subsequently, he noticed desquamation on the glans penis and then between his buttocks. Before being referred to dermatology, he was treated with a high dosage of corticosteroids.

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

BACKGROUND Human amniotic membrane (AM) is the inner layer of the fetal membranes and consist of the epithelium, basement membrane and stroma. The AM has anti-inflammatory, anti-fibrotic, anti-angiogenic as well as anti-microbial properties. Because of its transparent structure, lack of immunogenicity and the ability to provide an excellent substrate for growth, migration and adhesion of epithelial corneal and conjunctival cells, it can be used for ocular surface reconstruction in many ocular pathologies including corneal disorders associated with limbal stem cell deficiency, surgeries for conjunctival reconstruction, as a carrier for ex vivo expansion of limbal epithelial cells, glaucoma surgeries and scleral melts and perforations. AM transplantation is a very useful armamentarium in the hands of the ophthalmic surgeons for treating a variety of ocular surface disorders caused by various Chemical, acids and alkali and also endogenous causes like severe dry eye, Steven Johnson Syndrome etc affect the ocular surface as it is a very sensitive and dynamic structure. The aim of the study is to evaluate the efficacy of Non-Preserved Human Amniotic Membrane Transplantation in ocular surface disorders with respect to re-epithelialisation, corneal clarity, degree of neovascularisation and visual outcome and compare its efficacy with that of preserved Amniotic Membrane Transplant. MATERIALS AND METHODS 40 eyes of 36 patients were subjected to amniotic membrane transplant from July 2016 to January 2018. Non-preserved amniotic membrane was employed to cover corneal ulceration due to dry eye syndrome (12 eyes), non-healing corneal ulcers (12 eyes), corneal epithelial defect due to Steven Johnson Syndrome (8 eyes), conjunctiva and corneal epithelial defect due to alkali burn (8 eyes). Amniotic membrane sutured to surrounding conjunctiva using 10-0 silk with interrupted suture. Patients were followed up to 6 months. Sutures removed on 31st day of transplant. RESULTS Out of 40 eyes of 36 patients with mean age group of 32.5 years, non-healing corneal ulcer (8 eyes; 20%), dry eye syndrome (8 eyes; 20%) and Steven Johnson syndrome (4 eyes; 10%) showed resolution of epithelial defect and stabilization of neo vascularisation. 4 eyes (10%) of alkali burn responded favourably but retransplantation of Amniotic membrane to 2nd eye (10%) of the same patient, on 45th day had to be done. Over all 4 eyes of Steven Johnson syndrome, 4 eyes of dry eye syndrome, 4 eyes of persistent sterile corneal ulcer failed due to unrelated bacterial keratitis. Corneal clarity and improved visual acuity were observed in 60% of patients on day 31st. Transplantation in 16 eyes (40%) failed and was sent to higher center for further management. CONCLUSION Non-preserved human amniotic membrane transplantation is a safe and equipotent procedure as compared to preserved amniotic membrane in ocular surface reconstruction where facilities for preservation are not available and continuing medical management bears higher risk.

A 70 year old man presented with systemic signs of toxic epidermal necrolysis (TEN) following consumption of diclofenac tablets for a prodromal illness a week back. Ophthalmic evaluation showed no perception of light in both eyes along with lid edema, total corneal sloughing, and pus-filled anterior chamber. An amniotic membrane transplant was planned but within a few hours, both eyes developed panophthalmitis with restricted extraocular movements and mild proptosis and had to be eviscerated. This is perhaps the first case showing such devastating sequelae of TEN.

Steven Johnson syndrome (SJS) is a rare drug induced mucocutaneous reaction. Here, we present an elaborate report of a 28-year-old female patient who developed Phenytoin induced SJS, which was exacerbated by cefepime.

Trimethoprim-sulfamethoxazole (TMP/SMX) is a widely prescribed antimicrobial for the management of several uncomplicated infections. It is commonly used for the treatment and prophylaxis of Pneumocystis jirovecii pneumonia (PCP) in the HIV-infected population. The adverse reaction to TMP/SMX is more frequent and severe in HIV-infected patients as compared to the general population. Here, we report a case of Stevens-Johnson syndrome (SJS) secondary to TMP/SMX. The patient had a generalized cutaneous reaction with involvement of the eyes, oral cavity, and genitals. He had elevated hepatic alanine aminotransferase and aspartate aminotransferase enzyme. TMP/SMX therapy was stopped and supportive treatment was started. His condition improved after eight days of stopping TMP/SMX therapy.

Cutaneous adverse effects to antimicrobials are a major health problem. Though majority of them are mild and self-limiting, severe variants like Steven Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN) are not uncommon. Ofloxacin, a fluoroquinolone widely used for the treatment of urinary tract infections, acute bacterial diarrheas, enteric fever, STDs and other soft tissue infections either as a single drug or in combination with other drugs. Earlier a case of mucocutaneous maculopapular rash with oral ofloxacin and was reported in an adult. In the present hospital set up there were few reports of such reactions to adults. Here we report three different variants of reactions associated with oral ofloxacin in chlidren. Early detection of cutaneous lesions and immediate withdrawal of the offending drug can prevent progression of such reactions to their severe variants as well as morbidity and mortality.

Erythema multiforme, (EM) an u ncommon, acute inflammatory reactive mucocutaneous disorder and primary allergies confined to the oral mucosa. However the subsequent attacks can produce more severe forms of EM involving the skin. Manifestations of EM are varied and Present a diagnostic dilemma because infections (particularly herpes simplex and mycoplasma pneumoniae) and drugs seem to predispose towards development of EM. We report two cases of erythema multiforme in which drugs (Dioclofenac sodium & Amoxycilline) seems to be precipitating factor. In addition, the article reviews various aspects of EM as relevant to dental practice and highlight the associated potential etiologic agents, pathogenic mechanisms and therapies.

Kožne nuspojave povezane s korištenjem amlodipina su rijetko opisane. Najčešća kožna reakcija povezana s tim lijekom je pojava flushinga. Ostale kožne promjene, osim pojave urtikarije i eritematoznog makulopapuloznog osipa, koje su najčešće posljedica alergijske reakcije na ovaj lijek, uključuju i pojavu rosacee i fotodistribuirane teleangiektazije, koje zbog slične kliničke prezentacije ne bi smjelo pogrešno dijagnosticirati kao flushing. Iako su spomenute nuspojave većinom blaže do srednje klinički izražene, one uzrokuju značajnu nelagodu u bolesnika i mogu utjecati na terapijsku suradljivost. Osim spomenutih, primjena amlodipina je povezana i s nekoliko ozbiljnih i nepredvidivih kožnih nuspojava koji uključuju vaskulitis uzrokovan lijekovima te pojavu Steven Johnsonova sindroma. Spomenute kožne nuspojave su karakterizirane visokim morbiditetom te čak mogućim smrtonosnim ishodom. Iako su te reakcije općenito rijetke i neuobičajene za primjenu amlodipina, važno ih je identificirati kao moguće reakcije preosjetljivosti uzrokovane tim lijekom., Cutaneous adverse reactions associated with amlodipine have been rarely reported. Its most prevalent cutaneous side effect is fl ushing. Other recognized amlodipine associated skin eruptions, apart from urticaria and erythematous maculopapular rash which are most common allergic reactions, are rosacea and photodistributed telangiectasia which it is important not to misdiagnose as flushing, due to similarities in clinical presentations. Although these are usually mild to moderate skin side effects, they can cause serious discomfort and affect the patient´s treatment compliance. Apart from these mild drug reactions, amlodipine use is associated with other more severe and nonpredictable skin disorders including drug induced vasculitis and Steven Johnson syndrome. These cutaneous adverse drug reactions are characterized with high morbidity and even possible lethal outcome. Although these reactions are in general rare and uncommon in the use of amlodipine, it is important to acknowledge them as a possible hypersensitivity syndrome induced by this drug.

In everyday clinical practice, almost all physicians come across many instances of suspected adverse cutaneous drug reactions (ACDR) in different forms. Although such cutaneous reactions are common, comprehensive information regarding their incidence, severity and ultimate health effects are often not available as many cases go unreported. It is also a fact that in the present world, almost everyday a new drug enters market; therefore, a chance of a new drug reaction manifesting somewhere in some form in any corner of world is unknown or unreported. Although many a times, presentation is too trivial and benign, the early identification of the condition and identifying the culprit drug and omit it at earliest holds the keystone in management and prevention of a more severe drug rash. Therefore, not only the dermatologists, but all practicing physicians should be familiar with these conditions to diagnose them early and to be prepared to handle them adequately. However, we all know it is most challenging and practically difficult when patient is on multiple medicines because of myriad clinical symptoms, poorly understood multiple mechanisms of drug-host interaction, relative paucity of laboratory testing that is available for any definitive and confirmatory drug-specific testing. Therefore, in practice, the diagnosis of ACDR is purely based on clinical judgment. In this discussion, we will be primarily focusing on pathomechanism and approach to reach a diagnosis, which is the vital pillar to manage any case of ACDR.