Widespread Maculopapular Rash Research Articles

Coronavirus-disease-2019-associated Stevens–Johnsons syndrome in a 15-year-old boy: a case report and review of the literature

BackgroundStevens–Johnson syndrome (SJS) is a life-threatening condition characterized by high fever and severe mucocutaneous lesions, often triggered by drugs or infection. During the coronavirus disease 2019 pandemic, there was a marked increase in Stevens–Johnson syndrome cases, but relatively few cases were reported in children. The present article reports a pediatric case of Stevens–Johnson syndrome due to coronavirus disease 2019 infection and provides a review of the most relevant literature.Case presentationA previously healthy 15-year-old Han Chinese boy from China presented to the hospital with oral ulcers, conjunctival hyperemia, and widespread maculopapular rash. He had a history of fever 9 days prior and tested positive for coronavirus disease 2019 infection. Upon admission, his rash and mucosal lesions worsened, with the development of blisters on the fingertips of both hands, ocular pain, photophobia, and erosive lesions on the genital mucosa with exudation. He was diagnosed with Stevens–Johnson syndrome and received treatment with methylprednisolone, intravenous immunoglobulin, and dermatological and mucosal care. The patient’s condition was managed, and the dosage of high-dose intravenous methylprednisolone was tapered down, followed by a transition to oral prednisolone. He was discharged without sequelae.ConclusionWe should be aware that coronavirus disease 2019 infection is associated with the development of Stevens–Johnson syndrome in children and may lead to a wide spectrum of dermatologic presentations. Although Stevens–Johnson syndrome is a relatively rare condition, given its potentially serious consequences, it is crucial to identify it as early as possible and to take appropriate preventive and therapeutic measures to reduce complications and improve the quality of life for patients.

Measles infection causing Bacillus Calmette-Gu\xe9rin reactivation: a case report

BackgroundReactivation of the Bacillus Calmette-Guérin (BCG), manifesting as erythema, induration, ulceration or crust formation at a previous BCG inoculation site, is a common and highly specific feature of Kawasaki disease (KD). We report the unusual finding of BCG reactivation in an infant with laboratory-confirmed measles.Case presentationA previously healthy 7-month old infant presented initially with fever, cough and coryza, and subsequently developed Koplik’s spots followed by a typical morbilliform skin rash. There was significant contact history with a household relative who had recently been diagnosed with measles. On examination, a 2.5 cm area of erythema and induration was seen at the previous BCG inoculation site, in addition to the widespread maculopapular rash. No other clinical features of KD were present. Measles virus was isolated from the throat swab and measles antibodies (IgM) were present in the serum. The patient recovered completely with oral vitamin A and supportive therapy, and had normal echocardiography examination on follow up.ConclusionsThis case report highlights the rare finding of BCG reactivation in a child with confirmed measles infection, and suggests that this clinical manifestation may occasionally occur in children with infections or conditions other than KD.

MON-248 HERBAL BITTER: A RARE CAUSE OF ACUTE TUBULOINTERSTITIAL NEPHRITIS

Acute interstitial nephritis is an immunologically driven condition characterised by an inflammatory infiltrate in the renal interstitium. The use of herbal remedies has increased globally and has been described as a risk factor for the development of kidney injury, causing a variety of renal syndromes. We present a unique case of biopsy-proven acute interstitial nephritis following ingestion of an herbal bitter health drink, which was associated with a skin rash and eosinophilia. A 72-year-old-man presented with a 1-week history of general malaise, rash and fevers. His physical examination revealed a widespread maculopapular rash and pitting oedema to the knees but otherwise a normal examination including vital signs. His blood pressure on admission was 124/70. Four days into admission, his renal function deteriorated with a serum creatinine level rising to 411μmol/L (baseline of 98 μmol/L). One week into admission, he had a peak serum creatinine of 651 and was also oligouric. A renal biopsy revealed an interstitial infiltrate with a rich population of eosinophils. The findings were diagnostic of tubulointerstitial nephritis; the presence of eosinophils supporting a drug-induced cause. He had no recent alteration to his medications. On further questioning, the patient noted that one month prior to admission, he had started consuming an herbal bitter health drink. He was treated with intravenous methylprednisolone and a tapering dose of prednisolone, with the patient’s kidney function returning to baseline four weeks after the commencement of steroids. The herbal health drink ingested by the patient in this case, comprised of a combination of bitter herbs, consisting of a blend of seven herbal bitters. To the best of our knowledge, this is the first case of biopsy-proven acute interstitial nephritis induced by this multi-herbal health drink. This case report highlights the importance of taking a thorough medical history including establishing the use of over-the-counter medication and herbal remedies in the drug history. Furthermore, the importance of a prompt histological diagnosis in the form of a kidney biopsy is warranted, particularly in the case of drug-induced acute interstitial nephritis, as the mainstay of treatment involves cessation of the causative agent.

Management of carbamazepine induced drug reaction with eosinophlia and systemic symptoms in Mediheal hospital-Nakuru, Kenya: a case report

<p class="abstract">Adverse drug reactions (ADR) are undesirable events occurring as consequences of an ingested, injected or applied drug. Their spectrum can range from mild to severe reactions. Severe Cutaneous Adverse Reactions (SCARs) are diverse in presentation and in consequence. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) is a type of life-threatening SCAR which affects the skin as well as the internal organs. Various drugs can cause DRESS, but aromatic anticonvulsants, especially carbamazepine are considered the major culprits. The diagnosis of DRESS requires a high index of suspicion followed by an intense sign-searching clinical examination guided by established criteria. We report a previously healthy 53 year old man of Kenyan ancestry who developed fever, widespread maculopapular rash, swollen eyelids and cervical lymphadenopathy three weeks after carbamazepine. Liver enzymes were markedly elevated and he had lymphocytopenia and a positive serology for human herpes virus type 6 (HHV6). Using the RegiSCAR criteria a probable diagnosis of DRESS secondary to carbamazepine was made. His treatment involved discontinuation of the drug, intravenous hydrocortisone together with mild topical steroids. He remarkably improved and was discharged on oral prednisone and followed up for three consecutive months. The length of his hospitalisation was ten days. Carbamazepine has potential to provoke DRESS in patients of Kenyan ancestry. DRESS should be anticipated before and during use of carbamazepine for early recognition. Treatment of DRESS should involve the immediate withdrawal of offending drug and rapid initiation of systemic corticosteroids as well as application of diluted topical steroids to sooth the skin.</p>

DRESS syndrome presenting like septic shock

### Learning Point for Clinicians DRESS syndrome is a life-threatening drug reaction. It should be considered in patients who present with a sepsis-like illness of unknown origin, widespread rash, oedema, eosinophilia and lymphadenopathy who fail to respond to antibiotics and are on certain medications such as anti-convulsants, allopurinol and sulphonamides. A 27-year-old presents with pyrexia of 38.2°C, lethargy and a sore throat. On examination she had marked cervical, axillary and groin adenopathy. Pharyngitis with visible pus on her right tonsil was seen along with a widespread maculopapular rash, mild facial puffiness and genital ulceration. The only past medical history of note was a sero-negative arthropathy affecting her left fore-foot. She had commenced sulphasalazine 5 weeks prior to admission but had stopped taking it when she developed genital ulceration. Laboratory investigations showed a moderate transaminitis, C-reactive protein of 220 mg/l [Normal: <10 mg/l] and a lymphocytosis (7 × 109/L [N: 1.50–4.00 × 109/l]), WCC (white cell count) 16 × 109/l [N: 4.00–11.00 × 109/l]. She was initially treated with amoxicillin …

A Case of Brucellosis Presenting With Widespread Maculopapular Rash

Human brucellosis is a multisystemic infectious disease with a broad spectrum of clinical manifestations. Severe complications involving musculoskeletal, nervous, genitourinary, and cardiovascular systems may be encountered during the course of the disease; however, cutaneous complications have been reported rarely. We report a patient with brucellosis in whom the main presenting clinical feature was a maculopapular rash and fever. He was initially diagnosed as brucellosis based on the standard tube agglutination test and blood culture positivity. Histopathologic examination of these maculopapular lesions showed perivascular and periadnexal inflammation with loose granuloma formation including giant cells. We emphasize that brucellosis is an infectious disease that should always be kept in mind in the differential diagnosis of a patient with rash and fever, especially in endemic areas.

Widespread maculopapular rash due to intramuscular interferon beta-1a during the treatment of multiple sclerosis

Widespread maculopapular rash due to intramuscular interferon beta-1a during the treatment of multiple sclerosis

Pharmacokinetics of 18F-labeled trovafloxacin in normal and Escherichia coli-infected rats and rabbits studied with positron emission tomography

Clin Microb Infect 1997; 3: 63-72 On page 67, Figure 3 was published in black and white, which did not allow proper examination of drug concentrations. We reproduce the color version below: Michel Tod, Olivier Lortholary, Christophe Padoin and Gilles Chaine Clin Microb Infect 1997; 3: 143-4 In this Letter to the Editors, the first word in the title was published incorrectly as intravenous. We reproduce the correct title above. Illustrated continuing medical education - Case 2Clinical Microbiology and InfectionVol. 3Issue 3PreviewA 24-year-old homosexual man presented with a one week history of headaches, myalgia, and a rash. He had not been eating well and had vomited once after drinking heavily at the weekend. He had recently returned from a holiday to the Mediterranean. On examination he was febrile (37.8 °C), had enlarged cervical and inguinal lymph nodes, and a widespread maculopapular rash. He had a mild pharyngitis and generalised lower abdominal tenderness. His white cell count was 2.9 × 109/l and his blood film is shown above. Full-Text PDF Open ArchiveErrataClinical Microbiology and InfectionVol. 3Issue 3PreviewClin Microb Infect 1997; 3: 63-72 Full-Text PDF Open Archive