Case presentation on toxic epidermal necrolysis

Case presentation on toxic epidermal necrolysis

1. PRESENTED BY RUMANA HAMEED ROLL NO : 170310820021 PHARM D VTH YEAR CASE PRESENTATION ON TOXIC EPIDERMAL NECROLYSIS

2. SUBJECTIVE NAME: XYZ D.O.A: 6-4-15 SEX: Female REG.No .: 12954/15 AGE: 30yrs DEPT: DVL1,FM1 ADDRESS: Ranga Reddy. OCCUPATION: Housewife.

3. 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.

4. 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.

5. OBJECTIVE

6. 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

7. 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

8. 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 .

9. USG ABDOMEN : IMPRESSION: Normal study. CHEST X-RAY : IMPRESSION: Normal study SKIN BIOPSY : Findings: Keratocyte cell death(apoptosis)

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

11. 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.

12. CUTANEOUS E XAMINATION DENUDED SKIN OVER THE BACK MACULOPAPULAR RASHES ALL OVER THE BODY

13. 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

14. TREATMENT

15. 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 .

16. PLAN FORMULA-TION DRUG GENERIC DOSE ROUTE FREQ, IV FLUIDS 2 NS +125% 2RL 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 Triamcinolone acetonide 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

17. PATIENT COUNSELLING

18. 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.

19. 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.

20. 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.

21. 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 ?

22. THANK YOU