A 25 year old male admitted to the medical college hospital with presenting complaint of fever, skin rashes and itching. Before admission he had consulted a local doctor for fever, who had prescribed him Tablet ciprofloxacin 500mg twice daily and Tablet. Paracetamol 500 mg thrice daily. The patient had taken 6 tablets of ciprofloxacin before he developed the above symptoms. On detailed clinical examination multiple erythematous papule and plaques were present on the face, abdomen and neck. Target (Iris) lesions were seen on the extersor surface of both upper and lower limbs measuring about 1-2 cm in size. Multiple erythematous lesion were also found in mucosa of soft and hard palate, Uvula and posterior pharyngeal wall. Lower lips were swollen and edematous, Lymphnodes in the neck were enlarged and tender. The clinical features with which the patient presented were similar to those seen in a typical case of erythema multiforme and the patient recovered after stopping ciprofloxacin, Further rechallenge with oral ciprofloxacin was not done in the interest of patient and due to ethical constraints. This case is being reported for rare and potential fatal drug reaction with ciprofloxacin.
Stevens Johnson syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are rare, potentially life threatening, severe mucocutaneous adverse reactions characterised by extensive epidermal detachment, erosion of mucosa and severe constitutional symptoms. However, the use of Carbamazapine may be associated with a plethora of adverse effects, the most serious being SJS/TEN, wherein the patient typically presents with fever, skin eruption and mucosal involvement. It occurs between 1/1,000 and 1/10,000 new exposures to the drug. Here, the authors report a case of severe life threatening SJS/TEN induced by Carbamazepine in a three-year-old boy who presented with high grade fever, skin rash and all mucosal involvement. This condition is best approached with immediate discontinuation of offending drug and prompt administration of oral cyclosporine. The case is being reported to emphasise the need for timely diagnosis and prompt treatment with Cyclosporin for successful outcome as it can cause irreversible organ damage or death if untreated early
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