Abstract
Toxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death. This is the first case report in Nepal of toxic epidermal necrolysis in puerperium. We present a case of a 28-years-old, P1L1 on fourth postoperative day following emergency lower segment caesarean section for cephalopelvic disproportion in latent phase of labour with uneventful antenatal period. She developed fever followed by rashes all over the body with hypotension, tachypnea and shortness of breath. Initially, she was diagnosed as a case of septic shock and transferred to intensive care unit from postnatal ward. She was managed with broad spectrum antibiotics and inotropes. Later on, it was found to be the case of Toxic epidermal necrolysis and managed with vancomycin and corticosteroids under the supervision of gynecology, dermatology and medicine team. Keywords: puerperium; toxic epidermal necrolysis; vancomycin.
Highlights
CC CC BYABSTRACT oxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death
Toxic epidermal necrolysis (TEN) is a severe mucocutaneous reaction, usually to drugs, characterized by blistering and epithelial sloughing.[1]. It is rare, affecting approximately 1-2 cases per million per year and are considered medical emergencies as they are potentially fatal.[2]. They are characterized by mucocutaneous tenderness and typically hemorrhagic erosions, erythema and more or less severe epidermal detachment presenting as blisters and areas of denuded skin
She had received intravenous Cefazoline 1gm first dose preoperatively and 3 doses thereafter 8 hourly, intravenous Metronidazole 2gm single dose postoperatively, prophylactically as per hospital protocol. Her intraoperative period was uneventful. She was perfectly alright till 2nd postoperative day
Summary
ABSTRACT oxic epidermal necrolysis is a potentially life threatening dermatologic disorder characterized by widespread erythema, necrosis and bullas, detachment of epidermis and mucous membrane resulting in exfoliation, possible sepsis and even death. We present a case of a 28-years-old, P1L1 on fourth postoperative day following emergency lower segment caesarean section for cephalopelvic disproportion in latent phase of labour with uneventful antenatal period. She developed fever followed by rashes all over the body with hypotension, tachypnea and shortness of breath. It was found to be the case of Toxic epidermal necrolysis and managed with vancomycin and corticosteroids under the supervision of gynecology, dermatology and medicine team. Her condition was improved and was discharged on her twenty-third postoperative day
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