PMC6589315_01
Skin rash over face and neck along with extensive blistering lesions with mucosal involvement.
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fig1
A 17-year-old young female from Kathmandu, Nepal, presented to the emergency department of the Institute of Medicine (IOM) with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (Figures 1-3).
Skin rash over the back of trunk.
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fig2
A 17-year-old young female from Kathmandu, Nepal, presented to the emergency department of the Institute of Medicine (IOM) with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (Figures 1-3).
Skin rash with bullae formation.
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fig3
A 17-year-old young female from Kathmandu, Nepal, presented to the emergency department of the Institute of Medicine (IOM) with a generalized painful skin rash along with extensive blistering with mucosal involvement for one day (Figures 1-3).
Clumping of red blood cell along the surface of the tube at 4 C.
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fig4
After incubation at 4 C for 3 minutes, macroscopic hemagglutination was observed as cell clumping in thin film of blood that clinged to the tube (Figure 4).
Disappearance of clumping while heating the tube at 36 C.
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fig5
The clumping disappeared when the tube was warmed at 35.8 C and reappeared at 4 C (Figure 5).
Clumping of red blood cell at 4 C in slide.
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fig6
Also, serial dilutions of the patient's serum were mixed with an equal volume of 0.2% washed human O group erythrocytes, and clumping was observed till titer of 1 : 128 dilution after leaving at 4 C overnight (Figure 6).
Disappearance of clumping while heating the slide at 37 C.
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fig7
The clumping is dissociated at 37 C (Figure 7).
Patient improving on azithromycin and supportive treatment.
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fig8
The same treatment was continued and her clinical symptoms improved (Figure 8).