A 26-year-old man with ocular complications after adverse reaction to phenytoin

摘要

A 26-year-old black man was admitted to the Burn Unitof Hamilton General Hospital, Ontario, following anadverse drug reaction to phenytoin. He was diagnosedwith toxic epidermal necrolysis (TEN) and Ophthalmologywas consulted to assess for ocular complications(Figure 1). The Score of Toxic Epidermal Necrosis(SCORTEN) for this patient was 2 (SCORTEN is a validatedseverity-of-illness score that is predictive of mortality;scores range from 0–7, with 2 corresponding to a12.1% mortality rate), because he was 120beats/minute, no electrolyte abnormalities (blood ureanitrogen, serum glucose, or serum bicarbonate), and adetached body surface of >10%.1 He had no comorbidities.His medical history was remarkable for epilepsy.The patient had 85% of his body covered in a thin vesicularslightly blistering rash. His systemic involvementincluded oral and orbital edema and ulceration of hislips, oral mucosa, scrotum, glans, and upper right chest.