There
was presence of crusting over the lips. His eyelids and lips were
swollen, and that was associated with blistering later on. There was
presence of mouth ulcer (Figure 3) and genital involvement was also
present. Nilkolsky sign was present (Figure 4).
Patient also complains of odynophagia but he was able to swallow some
liquids. He was first in his family to develop this type of reaction,
there was no any significant family history and he had no any previous
known allergy. A thorough review of the patient’s medical history
revealed that sodium valproate has been prescribed for her epilepsy
since he was 11 years old. On peer pressure of society, he visited to
his community medical practitioner, and he was switched to
carbamazepine. After 5th day of taking carbamazepine
patient develops itching and rashes all over the body. On
9th day patient condition became worse, and for that
reason patient visited to tertiary care hospital.
To find out cause of SJS-TEN overlap, carbamazepine was stopped and 4mg
dexamethasone and 25 milligrams of pheniramine maleate stat was given
for preventing the patient from further complication of this reaction.
After that his clinical symptom was improved.
The consultant evaluated and investigated the patient, and the following
vitals were observed: HR-76BPM, RR-18 breath/minute, BP-100/70 mmHg, and
Temp 100.20F. His laboratory investigations showed
mildly elevated alanine transaminase (ALT), aspartate transaminase
(AST), alkaline phosphatase (ALP), and C-reactive protein CRP, and
mildly decreased serum creatinine. There was no sign and symptoms of
infection was found as blood and urine test was negative. His complete
blood count (CBC), electrolyte profile, random blood sugar, and viral
markers was found to be normal. No skin biopsy was performed.