Chordoma is a rare and locally aggressive tumor that arises from the notochordal remnants and has an incidence of 0.1/100000 per year. It has a predilection for the axial skeleton and is the most common primary malignant tumor of sacrum. The mainstay of treatment is wide surgical excision but there is a risk of recurrence due to the infiltrating nature of the tumor. Here, we report a case of a 56-years male who complained of pain over his sacral region for the past two years along with episodic urinary symptoms, constipation, and weakness of both legs. Seven years after undergoing surgery and radiotherapy for his sacral chordoma, he was diagnosed with recurrent sacral chordoma and planned for reoperation. Subtotal excision of the chordoma was done which significantly alleviated his symptoms postoperatively. Timely intervention helps to improve the quality of life in patients with either primary or recurrent sacral chordomas.
Stevens-Johnson syndrome and Toxic Epidermal Necrolysis are acute mucocutaneous reactions hallmark of which is widespread necrosis and detachment of epidermis. SJS/TEN fall under the single disease spectrum with an incidence rate of 1.0 to 6.0 per 1000000 and 0.4 to 1.2 per 1000000 respectively. Here, we present a case of a 46 years female who developed a generalized erythematous rash over her body, 26 days after being exposed to phenytoin and sodium valproate. Given the strong association between SJS and antiepileptic drugs, and the usual presentation being within the first eight weeks of exposure to susceptible medications; we diagnosed her with SJS. Phenytoin and sodium valproate was withdrawn and she was managed with antihistamines and corticosteroids. She improved significantly within 15 days of our intervention. The mortality rates for SJS and TEN are up to 10% and 30-50% respectively. Early identification of SJS, discontinuation of triggering medicines, and prompt initiation of supportive therapy improve the prognosis.
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