Stevens-Johnson syndrome induced by carbamazepine andamitriptyline in diabetic patient: a case report

Stevens-Johnson syndrome (SJS) is systemic immune reactions (type IV hypersensitivity) that are usually present by blistering and erosions of skin and mucous membranes with involvement of multiple organ systems. The incidence of SJS is rare, with the common comorbidities are diabetes mellitus, epilepsy, hypertension, and stroke. This condition is associated with systemic proinflammatory state. Diabetes mellitus is a metabolic disorder that is characterized by abnormally elevated levels of blood glucose due to glucose intolerance, hyperglycemia, and impaired insulin secretion. Nowadays, pathogenesis of diabetes is considered to be dysregulation of immune factors that are recognized as important etiological components in the development of insulin resistance. We report a case of a 30-years-old man with fever and sore throat, who had type 2 diabetes mellitus (T2DM) and used carbamazepine and amitriptyline for diabetic neuropathy, then followed by redness and blistering on his lips, palates, face, and trunk which subsequently diagnosed with SJS.

A reminder of life-threatening reaction of hymenoptera sting cause anaphylaxis shock

The prevalence of hymenoptera sting in general population still high. Large local reaction (LLR) is more common manifestation but can also causeanaphylactic shock and loss of consciousness, or even cardiac or respiratory arrest that all is defined as severe systemic sting reaction (SSR). The risk is generally considered low for future SSR in subjects with LLR but need to be considered and recognized immediately. We reporteda case of 39-year-old women was stung by a wasp when driving motorcycle and presented to emergency room with anaphylactic shock (fulfill the amended NIAID/FAAN criteria). She also stung by wasp 2 years ago and cause her left upper and lower arms became swollen slowly and improved 3 days later after treatment with allergy drugs. Electrocardiography result refer to sinus bradycardia. Significant laboratory result showed hypokalemia (2.9 mmol/l). Patient treated by injecting epinephrine intramuscularly and glucocorticoids to preventing protracted symptoms and biphasic reactions.

The charcot joint osteoarthropathy: a case report

The Charcot Joint Osteoarthropathy also referred as Charcot foot syndrome is a serious lower limb-threatening complication of diabetes. A patient was diagnosed with Charcot joint osteoarthropathy (COA) and found to have uncontrolled Diabetes Mellitus since more than 10 years. This case is crucial considering that Diabetes mellitus is a common case that we encounter, but the consequences of not being controlled can lead to serious complications. Accurate diagnosis is not always easy and can be a considerable clinical challenge. It needs to be differentiated from other conditions that has similar symptoms. Early diagnosis and initiation of treatment is crucial to avoid devastating and permanent complications.