Discussion: Early detection and treatment of this disease can result in marked improvement in clinical outcomes and quality of life. The natural progression of untreated statin-induced immune myopathy is irreversible replacement of muscle fibers with adipose tissue, resulting in severe debility. Clinicians should consider this disease in patients with history of statin exposure, refractory muscle weakness, and elevated CK levels despite discontinuation of the statin and hydration. Most patients will require immunosuppression with
a corticosteroid and steroid-sparing agent (ex: Methotrexate). A unique feature of this case is resolution without immunosuppression, which may be owing to quick diagnosis and management before onset of muscle necrosis. Expectant management and close follow-up may be a feasible option in patients who show persistent clinical and biochemical improvement. Further studies regarding modifiable and non-modifiable factors relating to disease outcome are warranted.
STEVENS-JOHNSON SYNDROME SECONDARY TO VANCOMYCIN AND CEFTRIAXONE: A CASE REPORT Bailee Cummings, Emmanuel Guajardo; Tulane University, New Orleans, LA.
Introduction: Stevens-Johnson Syndrome (SJS) is a rare skin reaction characterized by painful blisters and sores that may develop on skin and/or mucosal surfaces. SJS most commonly occurs as a drug reaction to certain medications and can be life- threatening. Antibiotics are frequently implicated in the development of this syndrome; however, some classes are more common culprits than others Case: A 73-year-old female who developed diffuse skin sloughing and mucosal erosions two days after initiation of vancomycin and ceftriaxone for treatment of left hallux osteomyelitis. The patient presented for several days of dizziness, polydipsia, and polyuria. She was noted to be hyperglycemic with BG > 500 and found to have a new black spot on the tip of her left hallux. MRI showed findings concerning for osteomyelitis. The patient was started empirically on vancomycin and ceftriaxone. During administration of vancomycin, the patient complained of itching and was noted to have redness on her chest, so vancomycin infusion was stopped. She was given diphenhydramine and famotidine, and vancomycin was restarted at slower infusion rate.
The patient underwent left hallux amputation two days later. During the procedure, she was noted to have skin sloughing at the site of bovi pad placement and around the site of her peripheral line. Over the next couple days, she developed erythematous patches involving >20% of her body surface area with interval sloughing of her skin, mucosal erosions on her lower lip, and involvement of the palpebral conjunctiva of both eyes. Skin biopsy showed full- thickness epidermal necrosis with dermoepidermal detachment consistent with the diagnosis of Stevens- Johnson Syndrome. The patient was started on steroids prior to being transferred to a burn unit where she improved after 3 weeks of treatment. Discussion: Beta-lactams like ceftriaxone are more commonly known to cause SJS, but it can occur with other antimicrobials like vancomycin, although there are a limited number of cases reported in the literature. As in the case of this patient, early diagnosis of SJS is key, and being aware of potentially triggering medications such as these commonly used antibiotics is important.
SYSTEMIC SEQUELAE OF DENTAL INFECTIONS: ARE BRAIN ABSCESSES THE TIP OF THE ICEBERG? Erica Jones, Jacob Cunningham, Karen Curry, Christopher Wexler; Louisiana State University, Lafayette, LA.
Introduction: A well-documented complication of dental infections is the formation of brain abscesses, most commonly via direct contiguous spread or hematogenous dissemination. The most
common infectious agents are microbes which compose the flora of the oropharynx. Complications include neurologic deficits, seizures, and death.
52
Made with FlippingBook Digital Publishing Software