CASE REPORT
A 42-year-old-woman with history of methotrexate induced pruritis and severe skin reaction, She had ectopic pregnancy 2 years ago treated with methotrexate after which she developed severe stomatitis, leucopenia and severe inflammation of urinary bladder, diagnosed as mast cell activation syndrome at that time. Recently admitted with fever; generalised macular rash; buccal ulceration; and burning sensation in her eyes. the patient was admitted to critical care unit as a case of SJS. Further history revealed that she started treatment with carbamazepine 2 weeks before admission treating Trigeminal neuralgia. The medical history was otherwise unremarkable. On physical examination, there is erythema and painful erosions on both lips (fig 1), with several flaccid and ruptured bullae on the Rt hand, back, and legs. With generalized maculopapular rash with Target lesions all over the body in centrifugal distribution (fig 2-3). Patient complain of odynophagia but able to swallow some liquids. With involvement of genital mucosa. Nikolsky’s sign was positive (Figure 4).
Laboratory investigations showed mild leukopenia, no eosinophilia, thrombocytopenia with mildly elevated Aspartate aminotransferase (AST), Alanine aminotransferase (ALT) and C-Reactive protein (CRP). No symptoms or signs of infection with negative blood, urine and sputum cultures. No skin biopsy was taken.
Patient admitted to critical care unit, Carbamazepine discontinued immediately, patient received intravenous fluid maintaining positive balance, nutritional support, Eye care and wound care.
Steroid treatment was given for 5 days in the form of 40 miligram methyl prednisolone daily. On the 10th day patient was discharged.