PRESENTASI KASUS ALERGI

SEORANG PENDERITA ERYTHRODERMI EC.DRUG ERUPTION

YANG MENGALAMI REAKSI ANAPHYLAKTIK
 INTRODUCTION

Erytrodermi (Generilized exfoliative Dermatitis) is inflammatory skin

disease affecting the entire skin surface Rx hypersensitivities type IV

The most common causes erytrodermi  ID-SCALP

More than 135 drugs been implicated the causation, the most common 
antibiotics, NSAID, Chemotherapy drugs, HIV drugs, anti-seizure drugs etc

Anaphylactic shock is Rx hypersensitivities type I, serious allergic Rx,

rapid onset, multi-organ system Rx caused by release chemical mediators
from mast cell and basophils  can cause death.

The most common inciting agents are foods, drugs, hymeneptora stings,
IV contrast materials.
 INTRODUCTION

Typically causes an itchy rash, throat/tongue swelling, shortness of

breath, vomiting, lightheadedness or hypotension.

IgE mediated is the classic form, but others doesnt involve IgE
 CASE
Name : Mr. Nurhadi
Occupations : Self employee
Ages : 46 yo
Addres : Surabaya
Admission in Pandan 2 ward

Past Illness
• He was diagnosed as a case of History of present illnes
pulmonary Tb. On tx 1st line complaints of erythema along with
antitubercular drug since 5 mo ago. severe itching all over the body for 7 days
• He had history of rhinitis allergy after taking cold medications (Demacolin,
• No history of jaundice, chest pain, mefenamic acid and Dextamin).
palpitations and dyspneu
• No preexixting dermatosis
• No prior exposure chemical
precipitants for similiar conditions
 CLINICAL PESENTATION

Compos mentis, BP 130/80 HR 96x/mnt, RR 18x/mnt, Tax 37,5C,

Weght 65 kg Height 156 cm

HEAD & NECK

Anemia -, Icterus-, Cyanosis-, Dyspneu-,
no lymph node enlargment
CHEST EXAMINATIONS
Lung : son/son, ves/ves, ronchi -/-, wheezing -/-
Heart : regu;er rhytm, murmur-, gallop-
ABDOMINAL EXAMINATION
Flat, soepel, flank pain-, kidney & liver not palpable, normal peristaltic
sound
EXTREMITIES EXAMINATION
Unremarkable
 CLINICAL PESENTATION

BLOOD LAB

Hb 14,7g/dl, WBC 27060/ml,

Plt 238000/ml,
BUN 20,9 mg/dl, SCr 0,75 mg/dl,
Blood Glucose 246mg/dl,
Alb 2,5 mg/dl
ALT 26 U/L, AST 18 U/L
Na 136 mmol/L, K 4,0 mmol/L,
Cl 101 mmol/L

Skin efflorescence : generilized involvement of the body skin with extensive non
uniform dusky erythematous scaly plaques involving scalp, face, nape of the neck,
trunk, arms, legs, palms and soles
 Working Diagnose :
Erytrodermi ec s. mefenamic acid + DM type II + Pulmonary TB (on tx)

Planning diagnose :
IgE level, skin biopsy,

Planning Therapy :
Inf PZ 1500 ml/day
B2 diet
Inj. Methyl Prednisolone 62,5 mg OD  tapp off
Inj Omeprazole 40 mg twice daily
Tab CTM 3x2 tab
Betamethasone zalf
Insulin long acting 0-0-10 IU
Moisturizing cream
Discontinuating all medications before
 DISEASE PROGRESSION

2 days after, he experiance exactly the same

3rd day  itching + dyspneu+ cough+
after eating lunch pack (pindang)
hoarseness + nausea+ vomiting+ cutaneus
warmth & pruritus, angioedema, low blood
Ass : Food induced anaphylactic
pressure begin 10 mnt after eaten (no
Tx anaphyactic protocols, strict monitoring
mediactions given during 2 hours before)
for the next 72 hours, avoiding suspected
Ass : Anaphylactic shock
food
Tx : Anaphylactic protocols, reffered to
intermediate room and strict monitoring for
the next 72 hours
 INITIAL MANAGEMENT
Regardless the underlying cause, the initial management
are :
• Remove any potential offending &unnecessary
medications
• Address nutrition, fluid and electrolyte balance
• Provide local skin care
• Oral antigistamines, systemic and topical steroids
• Systemic antibiotics if needed
• Evaluate signs & systems of cardiac or respiratory
comprimise
 PROGNOSIS ERYTRODERMIA
• Prognosis depends on the underlying cause
• Determining the etiology & removing any
contributing factors (medications)  the most
important factors in treatment
 ANAPHYLAXIS
• Systemic allergic reactions, multiple organ
• Acute onset, manfestation vary, can be fatal
• Common causes :
 Foods, venoms, medications, latex, exercise,
immunotherapy
 Symptoms :
 Skin flushing, itching, hives, swelling, nasal congestion, runny
nose, wheezing, hoarseness, chest/throat tightness,
abdominal pain, nausea vomiting, dairhhea, low BP,
arrhytmiasor chest pain
 ANAPHYLAXIS TIME COURSE
• Uniphasic
– A single wave of symptoms, most common, no
recurence / sequelae
• Biphasic
– Symptoms recur 2-4 hr later (up to 8hr), 10-20% of
food Rx
• Protracted
– Very rare, Rx persist for hours to days
 Anaphylactic protocols
1. Remove allergen
2. Call for assistance
3. Lay on flat surface
4. Give IM of adrenaline 1:1000 IM into outer mid-
tigh, 0,01mg/KgBW, repeat every 5min as needed,
adrenaline infusion
5. Give oxygen
6. IV saline (20m0l/KgBW) rapidly if hypotension
7. Salbutamol 5mg nebule if wheezing +