Novianti Rizky Reza

Chief Complain : Red Patches on face, neck and both arms

History : Redness patches on her face, neck and shoulder 3days before admission. First patch appeared on the face then spread on neck and arm. She complain about pain swallowing and black crust in her lower lips and sariawan in her mouth She had no fever, no pain micture, She take some medicine for diabetes melitus since april 8th 2010 and also take jamu. There were no previous same complain before Patient went to local clinic and reffered to RSSA

Past Ilness history : There were no history of the same disease before No history of another skin disease before Diabetes mellitus since a month before and she got Gludepatic , Glimepiride and Carbamazepin form dept, int medicine There were no history of hipertension No history of drug allergy Atopic was denied

L : face D : Scatered E : Erithematous macule, well define, irregular shape and various in size L : Lips D : Scattered R : erithematous macules, well define, irregular shape, vesicle, erosion and black crust in lower lips

L : both upper arms D : Scattered E : Erithematous macules, well defined, round shape, some of them confluences, there are erithematous papule in the center of the macules (target lesion)

L : Upper trunk D : Scatered E : Erithematous macule, well define, irregular shape and various in size

L : Back D : Scattered E : Erithematous macules, well defined, round shape, some of them confluences, there are erithematous papule in the center of the macules (target lesion)

L : both feet D : Scattered E : Erithematous macules, well defined, irregular shape

L : Palms and soles D : Scattered E : Erithematous macules, well defined, round shape, some of them confluences, there are erithematous papule in the center of the macules (target lesion)

Compos mentis, GCS 4-5-6 Vital Sign : P: 120/80 mmHg PR: 100x/m BT: 36,9 C RR: 18x/m Eyes : anemia -/-,ict -/- secrete -/Neck : no enlargement of lymph Heart : wnl Lungs : wnl Abdomen : wnl Extremities : edema -/-

 Erythema

Multiforme Stevens Johnson Syndrome

 Red

patches on face, lips, upper trunk, both arms and feets Pain on swallowing Diabetes Mellitus

 Erithema

Multiforme

PDx: Blood, LFT, RFT,electrolyte Consult to internal med dept Ptx : Stop the suspected drug -- carbamazepin IUFD normal saline 20 drop/min Metyl Prednisolon inj 25mg-0-0 Ranitidin inj 2x1 amp Wet dressing with NS

Hb Hematocrite Leukocyte Trombocyte RBG Ur/Cr

11.5 gr/dl 36.5/mm 8200 /mm 153800/mm 208 24.3/0.61

SGOT/SGPT Na/K/Cl

58/55 132/3.5/101

 DDS

: ODS dry eyes syndrome Therapy : Eyefresh 6x1 drop ODS

 DD
1. 2.

: Erithema multiforme Hyperglicemic state 1. Reactive 2. DM type II PDx : BG I/II, Check lipid profile Ptx : - Gludepatic 1x500mg - Glimepiride 2x5mg

April 27th 2010 (2nd day) S

O

Pain in swallowing Fell itchy in her eyes

L : face D : Scatered E : More numerous erithematous macule, well define, irregular shape and various in size Erithema Multiforme Hyperglicemic State IUFD normal saline 20 drop/min Metyl Prednisolon inj 25mg-12.5 mg-0 Ranitidin inj 2x1 amp Wet dressing with NS Consult opthamology dept

A P

April 28th 2010 (3rd day) Pain in swallowing

April 29th 2010 (4th day) Less pain in swallowing, patient eat well L : Face, neck and both arm D : Scattered R : Deskumation

April 30th 2010 (5th day) No pain in swallowing

Erithema Multiforme Hyperglicemic State IUFD normal saline 20 drop/min Metyl Prednisolon inj 25mg-12.5mg-0 Ranitidin inj 2x1 amp Wet dressing with NS

Erithema Multiforme Hyperglicemic State IUFD normal saline 20 drop/min Metyl Prednisolon inj 25mg-12.5 mg-0 Ranitidin inj 2x1 amp Wet dressing with NS

Erithema Multiforme Hyperglicemic State IUFD normal saline 20 drop/min Metyl Prednisolon inj 25mg-0-0 Ranitidin inj 2x1 amp Wet dressing with NS

Follow up April 30th 2010 (5th day)