CASE REPORT
A 42-year-old-woman with history
of methotrexate induced pruritis and severe skin reaction, She had
ectopic pregnancy 2 years ago treated with methotrexate after which she
developed severe stomatitis, leucopenia and severe inflammation of
urinary bladder, diagnosed as mast cell activation syndrome at that
time. Recently admitted with fever; generalised macular rash; buccal
ulceration; and burning sensation in her eyes. the patient was admitted
to critical care unit as a case of SJS. Further history revealed that
she started treatment with carbamazepine 2 weeks before admission
treating Trigeminal neuralgia. The medical history was otherwise
unremarkable. On physical examination, there is erythema and painful
erosions on both lips (fig 1), with several flaccid and ruptured bullae
on the Rt hand, back, and legs. With generalized maculopapular rash with
Target lesions all over the body in centrifugal distribution (fig 2-3).
Patient complain of odynophagia but able to swallow some liquids. With
involvement of genital mucosa. Nikolsky’s sign was positive (Figure 4).
Laboratory investigations showed mild leukopenia, no eosinophilia,
thrombocytopenia with mildly elevated Aspartate aminotransferase (AST),
Alanine aminotransferase (ALT) and C-Reactive protein (CRP). No symptoms
or signs of infection with negative blood, urine and sputum cultures. No
skin biopsy was taken.
Patient admitted to critical care unit, Carbamazepine discontinued
immediately, patient received intravenous fluid maintaining positive
balance, nutritional support, Eye care and wound care.
Steroid treatment was given for 5 days in the form of 40 miligram methyl
prednisolone daily. On the 10th day patient was discharged.