A 3-year-old male patient, with no relevant past medical history, began suffering 15 days before admission to hospital due to to tonic-clonic seizures with left-sided hyperthermia and gaze deviation of about 20 minutes.
Eight days after the first episode, the patient developed seizures of the same characteristics, with hyperthermia, general condition and non-poradic cough.
Treatment was initiated with Amoxicillin, Paracetamol, Diclofenac and Diphenylhydantoin.
She came to the scheduled appointment to undergo electroencephalogram, but she was referred to the emergency department because she had a fever peak of 40o C. Hyporexia, malaise, flushed lip mucosa, painful conjunctiva were also observed.
A cervical adenomegaly was found on the left side of 1.5 cm, abdomen blade and intact skin.
Probable diagnosis was made upon admission of Kaaki syndrome.
In the first 24 hours of post-engineering evolution, the patient presented clinical deterioration with non-conjunctival appearance, edema in the mouth and lip purulent secretion of both conjunctiva, tongue with whitish plaque, prominent cheek rash.
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At 48 hours after admission there were confluent vesicles and their sloughing in the anterior and posterior thorax, cheeks and auricular pavilions, lip bleeding lips and pharynx transmitted intercostal edema with presence of a nasal stern
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On the third and fourth days of hospitalization, an important epidermal fascia was observed, mainly on the face, loss of the face, tongue deflection of the mucosa, with an upper arm and upper abdomen closure of the posterior lid 45%.
The electrolyte requirements increased using the Galon formula and medical treatment was initiated with Clindamycin, Amikacin and Methylprednisolone.
Diffeidantoin and NSAIDs were discontinued due to a possible diagnosis of Staphiloco-scalded skin syndrome versus Stevens Jonson syndrome.
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Manufacturing
-BH Hgb: 12.4, Hto.
39.1%, VCM 80.2, HCM 25.5, CMHG 31.7, Leukocytes 19.6, Lymphocytes 29%, Eosinophils 3 %, Segmentation 66 %, 188 mm GL 1 %,
Epithelial cells: consolidation 1.020, Ph 5.0, yellow color, leucocytosis 2-3/field, trace ketones, scarce Christians and scarce epithelial cells.
Negative challenge.
Creoleites: No 139, K 4.2, Cl 101.
Blood chemistry: Total bilirubin 15, Unconjugated bilirubin 29, Total protein 7.1, Albumin ALT 4.0, Globulins 3.2, Creatinine 22GT 495, Glycine
Surgical lavage and skin biopsy were performed in the right inguinal region, as well as placement of a 3-way central catheter in the left groin to initiate total parenteral nutrition.
The bloody areas extended to 60 % of CS as well as the oral and perianal mucosae, with easy bleeding, which were covered with Lassar paste and Polymyxin.
A fibrous cream was observed on both corneas due to corneal sloughing, which was easily extracted and local medication was placed based on eye drops with Moxifloxacin and ciprofloxacin.
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The whole scheme of systemic antibiotics was changed by ceftriaxone, Vancomycin and Fluconazole, in addition to analgesia with Midazolam, Nalbuphine, Diazapam, Polymyxin in la.
Skin biopsy confirmed structural changes as a severe form of erythema multiforme of the type of Toxic Epidermal Necrolysis probably secondary to drugs (Anticonvulsants).
Blood cultures of the pharynx and eye secretion were negative.
New serial surgical lavages were performed under sedation and the wounds were covered with hydrocolloid dressings.
There was no improvement of the lesions until the third week.
Both eyelids showed synechiae that were released on multiple occasions, presenting corneal reepithelialization.
Its evolution went toward improvement, moving from the Intensive Care Unit to the hospital.
Once the abdomen was healed, a gastrostomy was performed due to the persistence of intraoral lesions.
The central catheter and Foley catheter were removed due to persistent fever.
Catheter tip cultures determined Staphilococo Aureus infection on day 30 of hospital stay.
She was discharged 36 days after admission with good general condition and continued medical treatment with psychological support in outpatient clinics.
Currently, she has sequelae from skin dyschromias, photophobia, starts walking with help, as well as tolerance to oral food.
Still under strict control.
