• Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
The HKU E-learning Platform in Clinical Medicine
The HKU E-learning Platform in Clinical Medicine
  • Physical Examination Skills
    • General Examination
    • Examination of the Cardiovascular System
    • Examination of the Gastrointestinal System
    • Examination of the Neurological System
    • Examination of the Respiratory System
    • Examination of the Musculoskeletal System
    • Demonstration on putting on a surgical/ N95 mask properly
  • eLearning Materials of Individual Divisions
    • Cardiology
    • Clinical Pharmacology
    • Dermatology
    • Endocrinology
    • Gastroenterology & Hepatology
    • Geriatrics
      • Common Physical Signs in the Geriatric Setting
      • Commonly used Assessments in the Geriatric Setting
    • Haematology
    • Infectious Diseases
    • Nephrology
      • General Nephrology
      • Imaging
      • Peritoneal Dialysis
      • Hemodialysis
    • Neurology
    • Rehabilitation Medicine
      • Modified Ashworth Scale
      • Complex Regional Pain Syndrome
      • Case 1
      • Case 2
    • Respiratory Medicine
    • Rheumatology
      • Common Rheumatological Cases
      • Clinical Signs and Radiographs of Patients with Rheumatological Disorders
  • Credits
Home
Dermatology

A Man with Pustular Dermatosis, Peripheral Eosinophilia and Deranged Liver and Renal Function Tests

November 20th, 2014

A Man with Pustular Dermatosis, Peripheral Eosinophilia and Deranged Liver and Renal Function Tests

A 38-year-old man presented with a 2-week history of generalized itchy skin rash and oral soreness. On admission, there was high fever of 40°C. Blood biochemistry showed deranged renal function (Cr 312 μmol/L) and raised liver parenchymal enzymes (ALT 219 U/L, AST 127 U/L). There was also marked peripheral eosinophilia of 8.1 x 10^9/L. He had a past medical history of congenital hydrocephalus and epilepsy. Phenobarbital was started 4 weeks ago for better seizure control.

On examination, there was generalized maculopapular eruption with pustules over the face and upper chest. Facial edema and oral erosions were also noted. No blisters were detected and Nikolsky’s sign was negative. The eyes and external genitalia were uninvolved.

Diagnosis

Drug hypersensitivity syndrome (DSH) is a distinct, severe idiosyncratic reaction associated with drug use. It is characterized by a triad of fever, rash and visceral involvement. Peripheral eosinophilia is usually present (90% of all cases). Mortality is high (up to 8-10%). Common offending agents include aromatic anti-convulsants and sulphur-containing drugs. Skin manifestations often present in the form of morbilliform eruption, erythroderma, acute generalized exanthematous pustulosis (AGEP), Stevens-Johnson syndrome and facial edema. The liver and kidneys are the most common visceral organs that may be involved resulting in hepatitis and interstitial nephritis.

Management

Rapid recognition and discontinuation of the culprit drug is the key of clinical management. Systemic steroids are often required to promote organ recovery.

In our case, the patient was treated with a short course of pulsed intravenous methylprednisolone therapy, followed by a course of oral prednisolone of tapering dosage. The skin eruption resolved completely and the liver and renal function normalized in 4 weeks time.

Related Posts

Nov 17th, 2014

An Elderly Woman with a Recurrent Itchy, Circinate Rashes

Nov 19th, 2014

A Woman with Linear Thickening of Skin on Left Index and Middle Fingers

Nov 20th, 2014

A Middle-aged Man with Pigmented Macules and Constitutional Symptoms

Nov 18th, 2014

A Middle-aged Man with “Dark Lines” over Fingernails

  • Click here - to select or create a menu