Case report for AP APICON Poster

Title: Hyperthyroidism with hypokalemic paralysisStevens-Johnson syndrome (SJS) / toxic

epidermal necrolysis (TEN) overlap syndrome due to oral phenytoin

: a case report

Sir, this patient was admitted under medicine unit 1I on 13/11/14th september 20187 with UHID

201800714907645900, seen by medicine associate professor Dr J. Harikrishna, assistant

professor Dr J. Hari Krishna and me a.nd dermatology senior resident Dr J. Indirakshi.

Patient details: Formatted: Line spacing: Double

Name: AgaramNampalli Nethaji Mallikarjuna UHID: 201800714907645900

Department/Unit: Medicine 1I

Date of admission: 13/11/20184/09/2017 Date of discharge:

16/11/201827/09/2017

Abstract category: Miscellaneous

Vasili Pradeep, J. Harikrishna, Alladi Mohan, *A. Surekha, **Pilla S. Surya Durga Devi, Formatted: Font: Bold
Formatted: Font: Bold
Institution: Departments of Medicine, *Dermatology, **Adverse Drug Reaction Formatted: Font: Bold

Monitoring Centre (AMC), Pharmacovigilance Programme of India, Sri Venkateswara Formatted: Left, Line spacing: 1.5 lines

Institute of Medical Sciences, Tirupati 517507

Abstract text: (Word Count = 250 words)

 • 39 years male known case of primary hyper thyroidism not on treatment since 3 years
presented to our tertiary care teaching hospital with sudden onset weakness of both
upper limbs and lower limbs on the proceeding day . Lower limbs >upper limbs, had no Formatted: Font: (Default) Times New Roman

h/o of excessive sweating, no h/o high carbohydrate rick diet, not a diabetic not on Formatted: Font: 12 pt

insulin treatment and no h/o usage of beta agonists and no family h/o periodic paralysis.
On examination, patient had exophthalmos, tachycardia and the other vitals being
normal, systemic examination revealed power of about 3/5 in both upper limbs and 0/5
in both lower limbs, DTR absent to +1,and the rest of the neurological examination was
normal. Formatted: Font: 12 pt

Stevens Johnson syndrome (SJS) is a rare but lethal manifestation of hypersensitivity reaction

precipitated by certain drugs and viral infections. Although among antiepileptics carbamazepine

is the most common cause of SJS, possibility of SJS by phenytoin should be considered. We

report the case of A14- year- old male , presented to medicine out-patient department at of our

tertiary care teaching hospital institute with a history of fever for the preceding 1 day. Four days

prior to this, Prior to this he had consulted ahe had developed 1 episode of neurologist in view of

generalized tonic-clonic seizures and was using oral phenytoin (100 mg bid ) for the last 4

days.since then. General p Physical examination revealed fever and bilateral conjunctival

congestion. He was admitted to medical intensive care unit. On the fFollowing day, fever

persisted and , he developed a maculopapular rash over face and , trunk; , ulceration s over lips

and skin peeling became evident involving >10% <30% body surface area. At this point in time,

a diagnostic possibility of an adverse drug reaction was considered and the patient’s history was

thoroughly reviewed again. Oral phenytoin was stopped and he was started on oral leviteracetam

(500 mg bid ). Dermatology consultation was sought. Based on clinical presentation the patient

was diagnosed to have SJS/ toxic epidermal necrosis (TEN) overlap syndrome. He was treated
with intravenous corticosteroids, topical antibiotics and symptomatic management. He

recovered, skin lesions subsided and was discharged in a stable condition after two weeks of in-

hospital stay. The present case documents the rare occurrence of SJS/TEN overlap syndrome as

an adverse drug reaction with phenytoin, early identification and stopping of offending drug will

aid in better management of patient.

Name of Presenting Author: N.MounikaVasili Pradeep

Designation: II year PG Junior Resident in MD (Medicine.)dicine)
J. Harikrishna,

Vasili Pradeep,

M. Soumya

*A. Surekha,

**Pilla S. Surya Durga Devi,

Alladi Mohan,

Niveditha Her SJ syndrome Formatted: Highlight

Pradeep SJ syndrome Soumya Formatted: Tab stops: 2.59", Left

Ganesh A Praveen Antisynthetase Formatted: Line spacing: Multiple 1.15 li