1/68. Skin eruption with gabapentin in a patient with repeated AED-induced Stevens-Johnson's syndrome.Skin eruptions have been reported with the use of all antiepileptic drugs and there is a significant risk of cross-reactivity between these agents in causing serious eruptions such as Stevens-Johnson's syndrome. Gabepentin is usually considered a safe agent for patients with a previous history of drug allergies and there have been no cases of skin eruption reported to the gabapentin post marketing surveillance. We report a patient who had severe Stevens-Johnson's syndrome induced by phenytoin and later by carbamazepine. Subsequent use of gabapentin also resulted in a skin eruption which was limited to the lower extremities but without systemic or mucosal involvement. This case suggests that patients with a strong history of drug-induced idiosyncratic reactions may experience such reactions to gabapentin as well.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
2/68. stevens-johnson syndrome. Description of an unusual clinical case due to glucocorticoid therapy for oral lichen planus.erythema multiforme (EM) is an acute inflammatory disease with an autoimmune pathogenesis clinically expressing in a wide variety of mucocutaneous illnesses. It is usually described in a minor form (Von Hebra) characterized by classical cutaneous lesions, and in major form (Stevens-Johnson), involving mucosal damage, while a clinical type restricted to the oral mucosa is described in oral pathology. A considerable number of factors of different nature have been reported as etiologic agents of EM, but most of them are not well documented; however, a certain relationship with EM is recognized for different classes of systemic drugs. This paper describes a case of stevens-johnson syndrome with initial oral involvement, in which the precipitating factor was due to the administration of systemic glucocorticoids, prescribed for the therapeutic treatment of an erosive form of oral lichen planus.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
3/68. The Steven Johnson syndrome. A case study.Steven Johnson's Syndrome is a serious systemic disorder in which there are vesicobullous lesions involving the skin and mucous membranes. It can result as an immune response to an antigen or as a drug reaction. Most often it is considered as an allergic reaction. It is a self-limiting condition which responds to immediate management or may result in fluid loss, sepsis and death.- - - - - - - - - - ranking = 116.0383158153keywords = mucous membrane, membrane (Clic here for more details about this article) |
4/68. Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens.PURPOSE: To report treatment of persistent corneal epithelial defects unresponsive to other therapies by extended wear of a fluid-ventilated gas-permeable scleral contact lens.methods: In this retrospective study, 14 eyes of 13 consecutive patients referred for the treatment of persistent corneal epithelial defects that failed to heal with conventional therapies or developed epithelial defects after penetrating keratoplasty for persistent corneal epithelial defects were fitted with an extended-wear gas-permeable scleral lens. These included seven eyes of six patients with stevens-johnson syndrome and seven eyes of seven patients who did not have stevens-johnson syndrome. Twelve eyes had undergone recent penetrating keratoplasty. All 14 eyes were fitted with a gas-permeable scleral contact lens designed to avoid the intrusion of air bubbles under its optic. An antibiotic and corticosteroid were added to the lens fluid reservoir or instilled before each lens insertion in 12 of 14 eyes. The lenses were worn continuously except for brief periods of removal for purposes of cleaning, replacement of the lens fluid reservoir, and examination and photography of the cornea.RESULTS: Five of the seven persistent corneal epithelial defects associated with stevens-johnson syndrome healed. The persistent corneal epithelial defects of four of these eyes re-epithelialized within 7 days, and a fifth healed in 27 days of gas-permeable scleral lens extended wear. A sixth persistent corneal epithelial defect that failed to heal initially re-epithelialized after a subsequent penetrating keratoplasty and gas-permeable scleral lens extended wear. The seventh eye healed after 3 days of gas-permeable scleral lens extended wear, but the persistent corneal epithelial defect subsequently recurred. Three of seven non-stevens-johnson syndrome persistent corneal epithelial defects re-epithelialized within 36 hours, 6 days, and 36 days, respectively. Of the six (six of 14) persistent corneal epithelial defects that failed to heal with a gas-permeable scleral lens extended wear, one subsequently healed after multiple amniotic membrane grafts. Microbial keratitis occurred in four eyes (four of 14) and graft failure in one eye, all of which required repeat penetrating keratoplasty.CONCLUSION: Extended wear of an appropriately designed gas-permeable scleral contact lens was effective in promoting the healing of persistent corneal epithelial defects in some eyes that failed to heal after other therapeutic measures. re-epithelialization appears to be aided by a combination of oxygenation, moisture, and protection of the fragile epithelium afforded by the scleral lens. However, microbial keratitis represents a significant risk.- - - - - - - - - - ranking = 0.59791402288398keywords = membrane (Clic here for more details about this article) |
5/68. stevens-johnson syndrome-like exanthema secondary to methotrexate histologically simulating acute graft-versus-host disease.A 61 year old male patient suffering from psoriasis vulgaris developed a severe skin reaction with toxic myelosuppression three days after administration of 20 mg methotrexate (MTX) p.o. per week and concomitant 100 mg acetylic salicylic acid (ASA) per day. The skin lesions simulated stevens-johnson syndrome with ulcerations of the oral mucosa and erythema multiforme-like target lesions. The histology of the epidermis resembled an acute graft-versus-host reaction. The increased toxic effect of MTX on keratinocytes in our patient was most likely caused by a lowered plasma binding capacity and reduced renal excretion of MTX due to concomitant administration of ASA. Thus in the treatment of severe forms of psoriasis with MTX, the combined administration of drugs aggravating MTX toxicity, particularly of ASA, should be carefully considered, due to the increased toxicity and risk of severe skin reactions.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
6/68. cocaine-related stevens-johnson syndrome.We report the case of a 26-year-old student with erosive skin changes on his oral and genital mucosa and skin as well as on his thighs twice after cocaine snorting. The second of these two episodes was documented histologically, and other underlying causes of disease were excluded. A diagnosis of recurring stevens-johnson syndrome was made. Treatment was initiated with bed rest, systemic prednisone at 1 mg/kg body weight and liquid nutrition. Mucosal changes resolved within 4 days. On follow-up the patient remained free of symptoms while abstaining from the particular cocaine street mix in question. cocaine has been involved in seizures, headaches, ischemic strokes, intracerebral hemorrhage, cerebral vasculitis, Churg-Strauss vasculitis, palpable purpura and Henoch-Schonlein vasculitis. Bullous skin disease in association with cocaine has been reported in 1 patient. To our knowledge, we report the first case of stevens-johnson syndrome associated with cocaine snorting.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
7/68. Development of a newly designed double-fixed Seoul-type keratoprosthesis.OBJECTIVE: To develop a newly designed double-fixed keratoprosthesis (Seoul-type keratoprosthesis [S-KPro]) and to assess its mechanical stability and biocompatibility. methods: Twenty-five rabbits were divided into 4 groups by fixation technique, amniotic membrane (AM) implantation, and skirt material. The eyes were studied with the use of slitlamp, light, and electron microscopy. Stress testing was performed. In addition, 2 human subjects underwent S-KPro implantation. Best-corrected visual acuity was checked, and ophthalmic examination was performed. RESULTS: The average retention period of the group receiving double-fixated polyurethane-S-KPro with AM was longer (>24 weeks) than that of the others. Fibroblast invasions were found in polyurethane pores but not in polytetrafluoroethylene (Gore-Tex) pores on light microscopy. The minimal pressure that induced aqueous leakage was greater than 250 mm Hg in all of the tested eyes. Two human subjects have maintained a good postoperative condition for 18 and 8 months. CONCLUSIONS: The double-fixation technique of applied S-KPro and AM appears to be helpful in improving the stability of the keratoprosthesis. Polyurethane with relatively large pore size (40 microm) may be used successfully as a material for the keratoprosthesis skirt. CLINICAL RELEVANCE: Our results may be important for improving the clinical outcome of keratoprosthesis.- - - - - - - - - - ranking = 0.59791402288398keywords = membrane (Clic here for more details about this article) |
8/68. Esophageal involvement in stevens-johnson syndrome.The authors describe the endoscopic aspect of esophageal lesions in five children with stevens-johnson syndrome. Lesions involve the entire esophagus, with blistering of the epithelium leading to large ulcerations of the mucosae. Esophageal involvement is probably underestimated in stevens-johnson syndrome and may worsen dysphagia caused by oral lesions, leading to malnutrition. enteral nutrition can be helpful to provide feeding, limit weight loss, and support skin healing. No strictures were diagnosed during the follow-up period of these patients.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
9/68. stevens-johnson syndrome in a patient receiving anticonvulsant therapy during cranial irradiation.A 28-year-old female patient with a recent history of breast carcinoma was referred to our clinic with generalized necrotic skin eruptions and severe mucosal erosions, which developed right after the completion of cranial radiotherapy for brain metastases. She had been receiving prophylactic diphenylhydantoin treatment 100 mg three times daily during radiation therapy. The extensive involvement of the oral mucosa with conjunctivitis and synechiae of the eyelids, facial swelling, and extension of the rash over the trunk and shoulders with bullous detachment of less than 10% of the total body surface strongly suggested stevens-johnson syndrome caused by phenytoin treatment in our patient. There has been conflicting evidence on the role of radiotherapy in the increased risk of severe drug reactions. Although various authors have emphasized the augmented rate of severe mucocutaneous reactions caused by anticonvulsants given during radiotherapy and suggested discontinuing the prophylactic use of such drugs in patients with no history of seizures, others have argued in favor of prophylactic anticonvulsants. Given the high risk of seizures, reaching 20% in patients with brain tumors, and the low incidence of drug reactions, the suggestion of refraining from prophylactic anticonvulsants in the setting of primary or metastatic brain tumors is controversial.- - - - - - - - - - ranking = 2keywords = mucosa (Clic here for more details about this article) |
10/68. stevens-johnson syndrome and cholestatic hepatitis.stevens-johnson syndrome (SJS) is a rare but severe dermatological condition that typically occurs after the ingestion of medications such as nonsteroidal drugs, antibiotics, and anticonvulsants. Extracutaneous manifestations of the syndrome can occur and may involve the conjunctiva, trachea, buccal mucosa, gastrointestinal tract, and genitourinary tract. Cholestatic liver disease, which may precede the skin manifestations of SJS, has been reported to occur in SJS, but the medical literature has only 10 case reports describing this phenomenon (1-9). We report the case of a 19-year-old female with SJS and cholestatic liver disease. A discussion of the underlying pathophysiology of SJS and its treatment follows.- - - - - - - - - - ranking = 1keywords = mucosa (Clic here for more details about this article) |
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