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Case Report
Immunodeficiency and post-operative antibiotic use leading to development of toxic epidermal necrolysis
1 Ascension Providence Hospital, Department of Obstetrics & Gynecology, Southfield, Michigan, USA
2 Michigan State University, School of Human Medicine, East Lansing, Michigan, USA
Address correspondence to:
Sayeh Nabati
Ascension Providence Hospital, Department of Obstetrics & Gynecology, Southfield, Michigan 48075,
USA
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Article ID: 100084Z08PA2021
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Agosta P, Halassy S, Miller S, Nabati S. Immunodeficiency and post-operative antibiotic use leading to development of toxic epidermal necrolysis. J Case Rep Images Obstet Gynecol 2021;7: 100084Z08PA2021.ABSTRACT
Introduction: The rarity of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) often lead to a missed diagnosis of a severe, life-threatening disease spectrum. Major risk factors include immunodeficiency and use of certain medications. Patients often present with fever and mucositis which can quickly lead to skin sloughing rash. Rapid diagnosis, treatment, and transfer to the Intensive Care or Burn Unit are essential preventing morbidity and mortality.
Case Report: Our case presents a patient whose initial complaint consisted of poorly controlled pain from a primary herpetic outbreak. Her hospital course eventually led to an unrelenting fever, oral lesions, and rash along her neck and chest rash which encompassed her entire body within 12 hours and led to sloughing of her areola and labia, and even labial agglutination. Rapid transfer to a Burn Unit, aggressive fluid hydration, and close monitoring were critical in her care.
Conclusion: The rapid progression and high morbidity and mortality rates make it important for healthcare personnel to recognize SJS quickly. Obstetricians and Gynecologists especially should have heightened awareness as the failure to provide a gynecologic exam can have devastating effects. Every patient with signs or symptoms of SJS, especially those with risk factors such as immunocompromise or use of specific medications, should undergo a prompt and thorough workup.
Keywords: Herpes simplex virus, Nitrofurantoin, Steven–Johnson syndrome, Toxic epidermal necrolysis
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Author Contributions
Patrina Agosta - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sophia Halassy - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sharon Miller - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Sayeh Nabati - Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Patrina Agosta et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
