Nursing care of a boy seriously infected with Steven–Johnson syndrome after treatment with azithromycin

Abstract

Rationale:Stevens–Johnson syndrome (SJS) is an acute blistering disease of the skin and mucous membranes. SJS in children is not common but potentially serious disease. But the epidemiology of SJS in China is not well defined.Patient concerns:A 6-year-old boy was initially diagnosed as pneumonia admitted to hospital after admission, and the body appears red rash with blisters, skin damage, lip debaucjed, repeated high fever, and rapid progression.Diagnoses:SJS often results from an allergy reaction response to a range of drugs. It is a clinical diagnosis suggested by fever and malaise followed by an extensive painful, nonblanching, macular rash that commonly progresses to blistering or sloughing, and mucositis.Interventions:The boy was treated with continuous renal replacement therapy, anti-infection therapy, high-dose glucocorticoid treatment, and symptomatic treatment.Outcomes:The patient was recovered after 33 days of treatment.Lessons:The current treatment is mainly symptomatic treatment, and for the patient, it is important to make skin care related well, included early out blisters at effusion, reducing skin ulceration of the mucosa area, keeping skin clean, removing mucosa secretion and blood clots, doing eye care related, preventing the complications, ensuring adequate intake of nutrition and warm and so on.

Diagnosis and management of the drug hypersensitivity reactions in Coronavirus disease 19: An EAACI Position Paper

“…Azithromycin has been implicated in contact dermatitis in occupational 75 and nonoccupational settings 76 . Cases of fixed drug eruption (FDE), 77 AGEP, 78 and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), 79 SJS, 80,81 leukocytoclastic vasculitis, 82 and hypersensitivity myocarditis 83 were reported(Table 2).…”

Treating COVID-19: Review of Drug Hypersensitivity Reactions

“…[20][21][22]. SCAR reactions with azithromycin include drug reaction with eosinophilia and systemic symptoms syndrome (DRESS) [23], AGEP [24], Stevens-Johnson syndrome (SJS) [25,26] and vasculitis [27].…”

Macrolide Allergic Reactions

“…There were 33 publications describing clarithromycin as a culprit for allergic reactions [72,73,75,78,79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102,103,104,105,106]. There were 31 published reports describing azithromycin associated allergic reactions [16,17,18,95,104,107,108,109,110,111,112,113,114,115,116,117,118,119,120,121,122,123,124,125,126,127,128,129,130,131]. Uniquely, the ophthalmic formulation of azithromycin was associated with contact dermatitis [119,123].…”

“…Erythromycin (n = 1), clarithromycin (n = 2), and azithromycin (n = 1) have been implicated in leukocytoclastic vasculitis [60,79,84,113]. Fourteen publications implicated a macrolide as the cause of an allergic reaction with subjects who received concomitant antimicrobials [25,41,44,45,46,58,76,78,90,101,102,105,119,131]. The most common concomitant agents were an aminoglycoside (n = 3), a beta-lactam (n = 3), and a sulfa (n = 4) [41,44,45,46,78,90,101,102,119,131].…”