RESUMO
The patient with febrile rash poses a real diagnostic challenge to primary care physician. We report an original case of febrile macular rash whose etiology was related to sepsis secondary to pelviperitonitis and acute cholecystitis. Patient's history, careful physical examination, paraclinical examinations and favorable outcome allowed to retain the infectious origin of the rash, without microbiological confirmation in our study. The skin is an excellent marker for infection. Cutaneous manifestations are the most common signs observed in patients with sepsis at an early stage. Exanthema is the most common lesion; it is due to systemic effects of a microorganism infecting the skin. If there are no clinical signs of infection, early diagnosis can prevent complications.
Assuntos
Colecistite Aguda/complicações , Exantema/etiologia , Peritonite/complicações , Sepse/complicações , Colecistite Aguda/diagnóstico , Exantema/diagnóstico , Feminino , Febre/diagnóstico , Febre/etiologia , Humanos , Pessoa de Meia-Idade , Infecção Pélvica/complicações , Infecção Pélvica/diagnóstico , Peritonite/diagnóstico , Sepse/diagnóstico , Sepse/etiologiaAssuntos
Dermatomiosite/diagnóstico , Hepatite C/diagnóstico , Linite Plástica/diagnóstico , Neoplasias Gástricas/diagnóstico , Idoso de 80 Anos ou mais , Dermatomiosite/complicações , Feminino , Pé/patologia , Mãos/patologia , Hepatite C/complicações , Humanos , Linite Plástica/complicações , Neoplasias Gástricas/complicaçõesRESUMO
INTRODUCTION: Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are life-threatening and severe adverse cutaneous drug reactions characterized by epidermal detachment presenting as blisters and areas of denuded skin. SJS, SJS-TEN overlap and TEN differ only by their extent of skin detachment. CASE PRESENTATION: We report here the case of a young woman (33- year old) admitted to the dermatological unit for epidermal detachment (at 18% of the body surface area), blisters, red macular and papular lesions, developed 15 days after administration of sulfasalazine. Prior to this, she complained of fever and discomfort upon swallowing. Skin biopsy had shown epidermal necrosis compatible with Stevens Johnson Syndrome and Toxic Epidermal Necrolysis. As the epidermal detachment was between 10% and 30%, she was diagnosed as a Stevens Johnson Syndrome/Toxic Epidermal Necrolysis overlap. The course was favorable 17 days after stopping the drug and starting a symptomatic treatment. CONCLUSION: Practitioners and patients need to be aware of the initial clinical signs of severe cutaneous adverse drug reactions such as fever, influenza-like symptoms, dysphagia or burning eyes. Early discontinuation of medication remains the best way to improve prognosis of patients with Stevens Johnson's Syndrome and Toxic Epidermal Necrolysis.