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34 year old male patient Nibin came to Zulekha Hospital with fever, eye congestion and pain in throat and found out that he was having severe allergy following his medication intake of (Tegretol) Carbamazepine. He had a life threatening type of skin condition called Stevens Johnson Syndrome / Toxic Epidermal Necrolysis with severe involvement of his eyes and skin. This is a very rare skin condition, with a genetic predisposition, the most common triggering factor usually a medication. He had a very severe involvement of his eye, skin, and cavity with blistering of skin similar to burns on one’s body. At times, the conditions can sometimes mimick a flu, conjunctivitis or viral fever like measles and patient may not seek treatment at the right time.
At Zulekha Hospital Sharjah, he was managed in the ICU by a multidisciplinary team including an Intensivist, Ophthalmologist, Dermatologist, Nurses, and a Nutritionist. Due to the timely diagnosis and management, the condition was under control and patient was discharged with all skin lesions healed and the eye involvement subsided in two weeks. The exemplary nursing care for skin and eye played a major role in preventing any complications. He was treated on high dose steroids, IVIG, medication complete eye care, skin care, cyclosporin, and multidisciplinary care in ICU. Nibin was being given fluid electrolyte and nutritional support as he could not take anything orally. Antibiotics were given to prevent any infections.
Specialist Dermatologist Dr. Aswathi Prasad at Zulekha Hospital Sharjah said, “We are glad Nibin did not develop any complications like a sepsis, eye complications like scarring or loss of vision. This severe drug allergy termed Stevens Johnson Syndrome, Toxic Epidermal Necrolysis overlap is a rare phenomenon, an unpredictable allergy which can be life threatening or leave a long term impact. Early diagnosis and treatment has prevented loss of vision or sepsis, multi-organ damage or even death of the patient.”
Zulekha Hospital expert team including Specialist Dermatologist Dr. Aswathi Prasad, Dr. Maged Abdulmagd - Consultant Intensivist, Dr. Islam Essam Eldin Elkousy - Specialist Critical Care Medicine, Dr. Kapil Anant Das - Specialist Ophthalmologist ensured timely involvement and administration of medication to save the individual’s life. Nibin has been advised to take care and be extremely cautious in future in using any medications belonging to the same group of medicines. He has been given an alert card with details, so that any future healthcare provider will be able to plan management accordingly. Regular follow-up with the ophthalmologist and dermatologist are recommended to keep track of his health until a full recovery is seen.
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