PRESENTED BY RUMANA HAMEED ROLL NO: 170310820021 PHARM D VTH YEAR

CASE PRESENTATION ON

TOXIC EPIDERMAL NECROLYSIS

SUBJECTIVENAME: XYZ D.O.A: 6-4-15

SEX: Female REG.No.: 12954/15

AGE: 30yrs DEPT: DVL1,FM1

ADDRESS: Ranga Reddy.

OCCUPATION: Housewife.

CHIEF COMPLAINTS: Watery elevated lesions over the right side of chest,inside and around mouth since 3 days.

HISTORY OF PRESENT ILLNESS :A 30yrs old female patient was admitted with the complaints of fever and watery lesions over the right side of chest, inside and around mouth since 3 days.Bullous erupted over the trunk and mouth.Spontaneous rupture of blisters seen.Pain present over the lesions.

PAST HISTORY:

History of Drug intake (phenytoin) present 8

days back for one episode of seizure.

History of UTI(Treated).

FAMILY HISTORY:No significant family history.

OBJECTIVE

VITALS

VITALS DAY 1 DAY 2 DAY3 DAY 4

BP/mmhg 110/70 110/80 110/80 110/80

Pulse rate/min

80/min 80/min 80/min 80/min

Temp-erature

101°F 99°F 98.6°F 98.6°F

LABORATORY DATA

RBS: 72mg/dl

Serum Urea: 32mg/dl

Serum Creatinine: 1.4mg/dl

SERUM ELETROLYTES

Sodium: 130meq/l

Potassium:3.0meq/l

Serum Total Bilirubin: 0.6mg/dl

COMPLETE BLOOD PICTURE:

Hemoglobin: 13gms/dl

W.B.C: 3200 Cells/Cmm

NEUTROPHILS: 64%

LYMPHOCYTES: 29%

EOSINOPHILS: 03%

BASOPHILS: 00%

PLATELETS: 2.5Lacs/cmm

BLOOD PICTURE: Normocytic,normochromic.

USG ABDOMEN: IMPRESSION: Normal study.

CHEST X-RAY:

IMPRESSION: Normal study

SKIN BIOPSY: Findings: Keratocyte cell death(apoptosis)

GENERAL EXAMINATION Patient is conscious and febrile Conjunctivitis - present.Conjunctivial congestion - +CCC - + Adhesions noted in the right eye. Ectropion – present. EOM : Full Early petrygium.

CUTANEOUS EXAMINATION

Discreet maculopapular rashes present all over

the body.

No confluent rashes present.

Erosions present.

Eroded mucous membrane over the lower lip.

Nikolsky’s sign - ++ (both direct and indirect).

Denuded skin present over the back.

No EMF lesions seen.

CUTANEOUS EXAMINATIONDENUDED SKIN OVER THE BACK

MACULOPAPULAR RASHES ALL OVER THE BODY

ASSESMENT:Maculopapular rashes all over the body and the detachment of the epidermal layer of the of the skin and the mucosa.Bullous erupted over trunk and mouth.Involvement of more than 30% of the body surface area.

FINAL ASSESMENT:TOXIC EPIDERMAL NECROLYSIS

TREATMENT

GOAL OF THE TREATMENT

Identify the causative agent and withdraw

it for better outcome.

To prevent and reduce fluid and skin loss.

To reduce and prevent infection.

To reduce inflammation and pain.

To improve survival and quality life of the

patient.

PLANFORMULA-TION

DRUG GENERIC DOSE ROUTE FREQ,

IV FLUIDS 2 NS +125%2RL DEXTROSE

INJ Monocef Ceftriaxone 1gm IV BD

INJ Decadron Dexamethasone 2cc IV BD

INJ Rantac Ranitidine 2cc IV BD

Tab. B.C B Complex 1 tab P/O OD

Tab. Calcium Calcium 1 tab P/O OD

Tab. Rantac Ranitidine 150mg

P/O BD

Ointment TESS Triamcinoloneacetonide

Oral Application

Gargle (mouth)

Betadine Povidone-iodine Oral Application

Eye drop Moisol Hydroxypropyl methyl cellulose,

Nacl,kcl.borax

0.5% 3-4 times a day

PATIENT COUNSELLING

DISEASE CONDITION

Toxic epidermal necrolysis also known as

lyell’s syndrome is a rare life threatening

skin condition that is usually caused by

reaction to drugs.

The disease cause the top layer of the

skin(epidermis) to detach from the lower

layers of the skin(dermis) all over the body

resulting in exfoliation,possible sepsis or

death.

MEDICATIONS MONOCEF: Antibiotic to treat and prevent infections.

DECADRON: Used to treat and prevent severe skin

skin inflammation.

RANTAC: H2RA,reduces the acidity.

BETADINE MOUTH GARGLE:

Oral antiseptic for relief of painful infections and

inflammatory conditions of mouth and pharynx.

TESS OINTMENT: Anti-inflammatory, Anti-pruritic,

and Vaso-constructive properties. To cure mouth

ulcers.

LIFESTYLE MODIFICATIONS Intake of large amount of fluids as there is a skin

loss.

Avoid spicy food.

Have proper and timely diet.

Stop the causative drug and avoid it in future.

Cool wet compresses will help it to soothe the

blisters while they heal.

Keep the eye hydrated by using the eye drops and

ointment.

Maintaining fluid and electrolytes homeostasis.

Mitigating temperature loss.

Take medications regularly.

DRUG INFORMATION QUERY

ACUTE COMPLICATIONS Similar to burns,

depends extent of occular complications

Massive fluid and electrolyte loss

Prerenal failure Hyper catabolism Mucous membrane

involvement. Bacterial infection, septicaemia.

CHRONIC COMPLICATIONS Occular complications

(upto 30%) Conjuntivitis, ectropion,

entropion, corneal scarring. Wound infection Nail dystrophy Scarring alopecia Oesophageal stricture

What are the complications of TEN?

THANK YOU