We report two cases with severe skin reactions following oral terbinafine (Lamisil) therapy. The first case was a 49-year-old woman with onychomycosis of the toe nails. She had suffered from diabetes for 3 years, but it was well controlled on insulin. Five days after start of terbinafine 250 mg once daily she developed erythema. The treatment was continued for 2 days, but the skin eruption progressed, and a clinical diagnosis of toxic epidermal necrolysis was confirmed histologically. The second case was a 51-year-old woman with dermatomycosis on the right foot. She developed a papular eruption in the second week after taking terbinafine 250 mg once daily. Despite this eruption she continued treatment for 6 days. Generalized erythema multiforme developed in the following days. Terbinafine is a recently introduced efficacious fungicidal drug. This is the first report of toxic epidermal necrolysis following terbinafine.
To determine whether anaesthetists are at risk from developing hepatitis-B virus (HBV) infection from their patients, 95 anaesthetists working with black South Africans (who have a high prevalence of hepatitis-B antigenaemia) were questioned about attacks of viral hepatitis and their blood was tested for hepatitis-B (surface) antigen (HBsAg) and antibody (Anti-HBs). Anti-HBs was detected in the serum of 17.9% of the anaesthetists, but none was a chronic carrier of HBsAg. Two anaesthetists had suffered from acute viral hepatitis during their careers, one of whom is now positive for Anti-HBs. Forty-five of the anaesthetists (47.4%) were known to have anaesthetized patients with HBs antigenaemia, and of these seven were Anti-HBs-positive. Anaesthetists working with a population having a high carrier rate of HBV appear to be more at risk from HBV infection than the general population.
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