Drug-related Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review.

INTRODUCTION: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, life-threatening, allergic reactions affecting the skin and mucous membranes. SJS is considered to be a milder form with less than 10% of body surface area (BSA) involvement. We report successful management of two cases of SJS and TEN. Firstly, a case of a 24-year-old female who presented with rashes over face, chest, and upper limbs after the oral intake of ciprofloxacin and local application of moxifloxacin eye drops. She developed high-grade fever and difficulty in breathing requiring intubation and lung-protective mechanical ventilation and was treated with high-dose methylprednisolone, azithromycin, soframycin skin dressings, and topical ocular antibiotics. Secondly, another case of a 16-year-old female who developed bullous eruptions over the trunk, arms, hands, face, and sole involving 60% of BSA, after oral intake of albendazole. She was diagnosed as TEN and successfully managed with sterile silver nitrate, soframycin dressings, and antibiotics. KEY MESSAGE: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening, allergic reactions affecting the skin and mucous membranes. Early identification, withdrawal of the suspected drug, and early transfer to a specialized center decrease mortality. HOW TO CITE THIS ARTICLE: Arora R, Pande RK, Panwar S, Gupta V. Drug-related Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Review. Indian J Crit Care Med 2021;25(5):575-579.

GuideWire Migrating into Murphy's Eye of Endotracheal Tube: An Unusual Complication of Percutaneous Dilational Tracheostomy.

Percutaneous dilational tracheostomy (PDT) is a frequently carried out bedside procedure in a critical care setting. It is usually performed under fiberoptic endoscopic guidance. Studies with PDT performed with endoscopic guidance have reported lower complication rates than studies performed with "blind" PDT. We report a case where PDT was performed without endoscopic assistance and the j-shaped guidewire got stuck in the Murphy's eye of endotracheal tube causing difficulty in railroading of tracheostomy tube (TT).