Drugs Eruption

DRUG ERUPTION IN HIV PATIENT

BY :Chek Natrah binti chek yum

Dwinda Aulia AFebryantobar K

CASE REPORTName : Mr. IAge : 29 Years oldAddress : Toddopuli 24/6 MakassarDate of Admission : 11 – 07 – 13 Hospital : RS Labuang Baji

HISTORY TAKINGAutoanamnesis:Chief complain: rashes on the whole of bodies.Brief anamnesis : happen since 3 days ago

after taking ARV medication (neviral). Rashes started with redness on stomach then continued on the whole bodies. Fever (-) and itchiness (+)

Past history: Patient has been treated in the hospital with HIV-AIDS since 2009. Received ARV, and this time he restart the ARV medication for the 3rd times.

PHYSICAL EXAMINATIONGeneral Condition : SevereConsiousness : Compos mentisNutrition : ModerateHygiene : ModerateVital Sign

BP : 110 / 70 mmHg P : 72 times / minute RR : 24 times / minute Temp : 36,5o c

PHYSICAL EXAMINATIONSclera : Jaundice (-/-)Conjunctiva : anemic (-/-)Lip :cyanosis (-/-)Cardio / pulmonal : normalAbdomen : normalExtremity : rashes in the four limbsLymphonodus : no enlargement

DERMATO- VENEROLOGY STATUS

Location : regio generalisataSize : multiple sizeEfflorescence : plaque eritomatous

Picture 1 : the rashes on the stomach and face with purplish red color.

Picture 2 : rashes with irregular shape and different size.

Picture 3 : the rashes also appears on the legs.

LABORATORY RESULTTest Hasil Keterangan/ Nilai

normalCD4 64 C/ul Lymphocyte T

helper sel sangat berkurang

SGOT 37 15-37 u/lSGPT 19 12-42 u/lUreum 11 15-39 mg/dlKreatinin 0.6 0.6-1.3mg/dlAlbumin 4.81 3.5-5GDS 94 74-140 mg/dlWBC 8.1X109 4-10x106

RBC 4.37X106 4-6x106

HGB 12.6 12-16PLT 294X103 150-300X103

HIV-TEST REACTIVE Non-reactive

FURTHER EXAMINATIONSkin biopsyDrug provocation testBlood test

RESUME29 years old man come to Rumah Sakit Labuang baji with chief complain rashes appear on the whole body. Its happen since 3 days ago after taking an ARV (anti-retro viral-neviral) drug. Rashes started with redness on stomach then continued on the whole bodies. Fever (-) and itchiness (+). Before this patient has been treated in the same hospital with HIV-AIDS since 2009. Received ARV, and this time he restart the ARV medication for the 3rd times.

Physical examination : General Condition is Severe, compos mentis, moderate nutrition, moderate hygiene. Vital Sign Blood Pressure 110 / 70 mmHg, Pulse 72 times / minute, Respiratory rate 24 times / minute, Axila temperature 36,5o C. Sclera : Jaundice (-/-), Conjunctiva : anemic (-/-), Lip : cyanosis (-/-), Cardio / pulmonal and Abdomen : normal, Extremity : rashes in the four limbs, Lymphonodus : no enlargement

Dermato-venerology status.Location : regio generalisata, Efflorescence : plaque eritomatous

From the anamnesis, physical examination, laboratorium result and status dermato-venerology from this patient we can conclude the diagnosis for this patient is drug eruption in HIV treatment.

DIAGNOSISDrug eruption in HIV patient.

Stop the drug that causes rashes.

MANAGEMENT

TREATMENT AND MANAGEMENT

1) HIV drug: -neviral 1-0-0-TDF 1-0-0-hiviral 1-0-1-Kotrimoxazol 80mg 1x1

2) Sistemik drug-NACL 0.9%-Methyprednisolon 4 mg 3x2 -cetirizine (anti-histamin) 1x1

3) Tropical drug-betametason-lanolin 10% (p-s)-vasolin aQa 30%

DISCUSSION

Drug eruptions are diagnosed mainly from the medical history and clinical examination. However, they can mimic a wide range of other conditions, thus delaying diagnosis (for example, in drug-induced lupus erythematosus, or the acne like rash). A skin biopsy, blood test or immunological test can also be useful. If the causative agent can not be withdrawn, the symptoms should be relieved as much as possible.

DISCUSSION

The most common type of eruption is morbiliform (resembling measles) or erythematous rash, but the appearance may also be urticarial, papulosquamous, pustular, purpuric, bullous ( with blister) or lichenoid. Angiodema can also be drug-induced.

DIFFERENTIAL DIAGNOSISFixed Drug EruptionsUrticaria

Fixed Drug Eruptions Drug eruption that occurs at

the same location every time a particular medication is used.

Begins as an erythematous, edematous plaque with a grayish center or frank bullae, then progresses to dark, post-inflammatory pigmentation.

Sites include the mouth, genetalia, face, and acral areas.

Causes include phenolphthalein, tetracyclines, barbituates, sulfonamides, NSAIDs, and salicylates.

Urticaria Time to onset: immediate,

accelerated (hours), or delayed (days).

Type I hypersensitivity reactions: antibiotics (especially PCN, cephalosporins, and sulfonamides), local anesthetics, radiocontrast media, blood products, and gamma globulin.

PROGNOSISIt depends on the underlying factorsIf the cause(s) can be found and removed

or corrected immediately then the prognosis is good

Thank You