PMC7307482_01
(a) Mucocutaneous blisters at the time of admission in ICU. (b) Healing of fluid-filled
blisters after 48 h of admission. (c) Complete re-epithelialization of the lesions on
12th day of admission.
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A 16-year-old girl admitted in our intensive care unit (ICU) with a history of taking cefuroxime /clavulanic acid (500 mg/125 mg, every 12 h, orally) 3 days ago at home, and after 48 h, she developed cefuroxime-induced TEN manifested by fluid-filled mucocutaneous blisters all over her body; hemorrhagic crusting of the vermillion zone of the lips (Figure 1(a)) with oral mucosal bleeding; and bilateral conjunctivitis. Within 2 days of admission, all the blisters stopped progressing (Figure 1(b)), oral-mucosal bleeding stopped, and no new blister regenerated. She was discharged from ICU on her 12th day of ICU admission, while significant re-epithelialization of the erupted skin (Figure 1(c)) was found all over her body.
PMC7307482_02
(a) Mucocutaneous blisters at the time of admission in ICU. (b) Healed blisters after
48 h of admission. (c) Day 9 of admission with complete re-epithelialization of the
lesions.
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ICU, and was found with fluid-filled mucocutaneous blisters in his chest, face, and neck; hemorrhagic crusting of the vermillion zone of the lips (Figure 2(a)) with oral mucosal bleeding; and bilateral conjunctivitis. In addition, he had fever (101 F), myalgia, increased heart rate (130 beats per minute), mild respiratory distress, increased serum creatinine level (1.9 mg/dL), increased serum BUN level (33 mg/dL), elevated serum bicarbonate level (26 mEq/L), raised blood pH (7.51), and reduced consciousness level (GCS score: E3V4 M5). After 48 h, the progression of the fluid-filled blisters stopped and no further blister developed (Figure 2(b)). A significant recovery of skin eruptions (Figure 2(c)) was found on day 9 of NAC therapy and he was discharged after 16 days of NAC-therapy.
PMC7307482_03
(a) Mucocutaneous blisters at the time of admission in ICU. (b) Healed blisters after
48 h of admission. (c) Day 4 of admission with suppressed skin lesions.
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SJS, and was admitted in our ICU with mucocutaneous fluid-filled blisters mostly in her chest, abdomen, and face (Figure 3(a)); oral mucosal bleeding; and bilateral conjunctivitis. She had premorbid hypertension, but no history of diabetes. Within 48 h of ICU admission, the blisters stopped further progression (Figure 3(b)), no new blister was formed, and hepatic functions returned to the normal range. A significant improvement in the healing of blisters was observed on day 4 (Figure 3(c)) with NAC therapy, clinically she was found sound, and was discharged to the general ward after her 12th day of admission in the ICU.