A Rare Pediatric Case of Cefixime Induced Toxic Epidermal Necrolysis.

Cefixime is a third-generation cephalosporin that has been used for the treatment of a wide range of infections in children and adults. The incidence of cefixime induced toxic epidermal necrolysis (TEN) is less than 2% in adults, but it is infrequent among pediatric patients. We report a rare case of cefixime induced TEN in a 7-year-old boy. In this case, the child presented with symptoms of TEN after 2 days of administration of cefixime. This case highlights the need to select structurally different antibiotics in case of antibiotic-induced severe cutaneous adverse reaction (SCAR) to avoid recurrence of SCAR. Furthermore, concluded that irrational use of antibiotics could be disastrous as it can result in TEN as the incidence of antibiotics induced TEN ranges from 29% to 42%.

A Rare Case of Dapsone Hypersensitivity Syndrome and Leukemoid Reaction With Coexisting Hepatitis E in a Pediatric Patient.

Dapsone is extensively used for a variety of infectious, immunological, and hypersensitivity disorders. Dapsone can cause several adverse effects, the most serious being dapsone hypersensitivity syndrome (DHS), which is potentially fatal. DHS is characterized by triad of eruptions, fever, and organ involvement (including liver, kidney, hematological system, etc.). DHS can develop several weeks to as late as 6 months after treatment initiation with dapsone. Here, we report a case of DHS and leukemoid reaction with coexisting hepatitis E in a 10-year-old girl. Three weeks prior to the current admission, she was treated with dapsone (1 mg/kg/day in two divided doses) for 8 days by a local doctor for lichen nitidus. She was managed successfully for DHS with intravenous (IV) steroids followed by the oral steroid. This case is being reported to highlight the importance to ensure timely diagnosis of DHS and its appropriate management. Patients started on dapsone for various clinical conditions need to be observed carefully for the development of the DHS. If this occurs, DHS can be mistaken for the progression of the primary disease. If dapsone is not withdrawn, it could have deleterious and potentially fatal effects due to major organ dysfunction.

Estimation of serum neopterin level as an early marker for detecting severe dengue infection.

BACKGROUND: This study aimed to determine the role of neopterin in the early assessment of dengue severity in children of age one month to 18 years admitted for fever and confirmed by dengue serology. METHOD: Two sets of samples were collected from 77 confirmed dengue patients aged one month to 18 years for serum neopterin determination. The first sample was collected at 2-3 days of fever onset, and the second sample was collected at 24-36 h after the first sample was collected and followed up cases and correlated serum neopterin levels. RESULTS: Among the 77 patients enrolled, 19 were diagnosed with severe dengue, 15 patients as having dengue with warning signs, and 43 patients as having dengue fever. CONCLUSION: In this study, we found that the serum neopterin levels were significantly higher in the severe dengue category (mean: 58.75(±4.91) nmol/l) than in the non-severe dengue category (mean: 48.11(±8.80) nmol/l). Furthermore, a positive correlation was observed between neopterin concentration and duration of fever hence, higher serum neopterin levels may indicate dengue severity. The determination of serum neopterin concentration may be used for the early assessment of severe dengue.