ro13-9904 and Stevens-Johnson-Syndrome

Fixed drug eruption (FDE) is defined as sharply demarcated erythematous patches or plaques that occur secondary to systemic exposure to a causative medication. Eruptions are deemed "fixed" because upon repeated exposure they recur at previously affected sites. Generalized bullous fixed drug eruption (GBFDE) is a rare FDE variant occurring in patients with a previous history of FDE. Given the extensive cutaneous involvement and the frequent mucosal ulcerations associated with GBFDE, it is challenging to discern these lesions from Steven-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The presence of significantly elevated lesional and serum granulysin in SJS/TEN is an important discriminating factor because granulysin levels remain significantly lower in GBFDE. The implementation of an immunochromatographic test for rapid detection of elevated granulysin levels could therefore facilitate the early diagnosis of SJS/TEN. We report a case of GBFDE to elucidate the characteristic differences in clinical presentation, histopathology, and immunohistochemistry that can facilitate diagnosis.

Topics: Antigens, Differentiation, T-Lymphocyte; Ceftriaxone; Diagnosis, Differential; Drug Eruptions; Female; Humans; Immunohistochemistry; Middle Aged; Skin; Skin Diseases, Vesiculobullous; Stevens-Johnson Syndrome

Topics: Adrenal Cortex Hormones; Allergens; Carbamazepine; Ceftriaxone; Child; Child, Preschool; Drug Eruptions; Female; Humans; Hypersensitivity, Delayed; Ibuprofen; Immunoglobulins, Intravenous; Male; Patch Tests; Penicillin G Procaine; Respiratory Tract Infections; Seizures; Stevens-Johnson Syndrome

TEN is a severe form of exfoliative dermatitis. Its course is acute and its outcome fatal in 40% of cases. Wound cover to prevent fluid/protein loss and infections and to control pain, is the first step, as for burns. Skin allograft can be successfully used for this purpose.. We report two cases of TEN with de-epithelialization of 50 and 70% of the total body surface area. The patients were given support therapy and treated with human glycerol-preserved skin allografts for wound cover.. Patients were grafted with glycerol-preserved donor skin, obtained from a skin bank.. Re-epithelization of treated areas was complete in 8 days; pain relief was obtained soon after the graft.. Glycerol-preserved skin allograft is an effective treatment in extensive skin loss, for its barrier and analgesic effect. Quality standards of this product ensure safety and simplicity of use at limited cost.

Topics: Aged; Aged, 80 and over; Ampicillin; Anti-Bacterial Agents; Ceftriaxone; Female; Glycerol; Humans; Male; Middle Aged; Organ Preservation; Ranitidine; Skin Transplantation; Stevens-Johnson Syndrome; Transplantation, Homologous

A case of the toxic epidermal necrolysis in a 52-year-old woman treated for hypoxia of cerebral trunk during the severe attack of bronchial asthma and the bacterial infection of respiratory system was described. The pause of toxic epidermal necrolysis was treated with ceftriaxone and cefuroxime. The woman died on the 20th day of disease.

Topics: Asthma; Ceftriaxone; Cefuroxime; Cephalosporins; Drug Therapy, Combination; Fatal Outcome; Female; Humans; Immunoglobulin A; Middle Aged; Respiratory Tract Infections; Stevens-Johnson Syndrome