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• W4387248520 abstract "SESSION TITLE: Critical Care Case Report Posters 9 SESSION TYPE: Case Report Posters PRESENTED ON: 10/09/2023 02:10 pm - 02:55 pm INTRODUCTION: Acute generalized exanthematous pustulosis (AGEP) is an acute presentation with skin reaction that is often attributed or assumed to be drug-induced in >90% of cases but lately many viral, and bacterial causes are increasingly being recognized. Due to similar initial clinical presentation and overlapping etiology, Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) often causes diagnostic confusion. CASE PRESENTATION: We present a case of 60 years old female (93 kgs) with a medical history of DM and HTN, who presented with generalized desquamation and rash involving the torso, back, and extremities but sparing oral, ocular, genital areas, palm, and soles for 7 days. The Rash later progressed to a bullous rash with blistering, on areas of the abdomen and extremities with a positive Nikolsky sign. At a presentation at an emergency department, she was treated for sepsis with intravenous antibiotics and steroids. Later she was noted to have melena with low hemoglobin of 6.3 gm/dl decreased from 11.2 a week before at her PCP office. Given her skin rash and melena with a SCROTEN score of more than 5 (mortality of more than 90%), she was initially managed as SJS/TEN and was treated conservatively in the special burn unit for further management. On review of labs, she was found to have a positive test with a titer of Mycoplasma pneumonia IgM was 1884 (0 - 99 U/mL) with negative blood cultures, autoimmune workup, HIV, Monkeypox, and COVID-19. In view of the sudden drop in hemoglobin, she underwent upper GI endoscopy and was found to have two nonbleeding cratered duodenal ulcers with a negative Helicobacter Pylori test which was managed with IV Proton pump inhibitors and packed red blood cell transfusion. She underwent a skin biopsy which showed AGEP. She was treated with a high-dose IV steroid which was tapered over 4 weeks with complete resolution of the rash on follow-up. DISCUSSION: Mycoplasma infection can cause URTI and pneumonia but can uncommonly be associated with autoimmune cold hemolytic anemia, carditis, hepatitis, and mucocutaneous involvement. The spectrum of skin rashes ranging from erythema multiforme to SJS/TEN are commonly associated with drugs but less commonly they are also associated with viral (CMV/Herpes virus) and bacterial (including mycoplasma) infections. Both SJS/TEN and AGEP appear to be immunologically mediated and both are associated with severe mucocutaneous lesions that share a somewhat overlapping clinical presentation, pathological, and management strategies. AGEP has an acute onset of presentation and has less propensity to cause mucosal involvement. AGEP has a better response to steroids, conservative management, and a better prognosis. The confluence of pustules in AGEP may result in a positive Nikolsky sign, leading to a diagnosis/overlapping with SJS/TEN. Early skin biopsy is prudent for definitive diagnosis and appropriate management of mucocutaneous lesions to decrease morbidity and mortality. CONCLUSIONS: Our case is unique as it had an initial clinical picture of SJS/TEN with limited mucosal involvement as GI bleeding/melena. This is probably the first of Mycoplasma pneumonia presenting as SJS/TEN and evolving pathologically to AGEP with subsequent complete recovery REFERENCE #1: Chowdhury TA, Talib KA, Patricia J, Nye KD, Moosa SA. Rare and Complicated Overlap of Stevens-Johnson Syndrome and Acute Generalized Exanthematous Pustulosis.Cureus. 2021 Jun 25;13(6):e15921. doi: 10.7759/cureus.15921. PMID: 34336425; PMCID: PMC8310679. REFERENCE #2: Copaescu, AM., Bouffard, D. & Masse, MS. Acute generalized exanthematous pustulosis simulating toxic epidermal necrolysis: case presentation and literature review.Allergy Asthma Clin Immunol 16, 9 (2020). https://doi.org/10.1186/s13223-020-0407-5 REFERENCE #3: Acute generalized exanthematous pustulosis simulating Stevens-Johnson syndrome/toxic epidermal necrolysis associated with the use of vismodegibMoreno-Arrones,Oscar M. et al, JAAD Case Reports, Volume 4, Issue 2, 123 - 125 DISCLOSURES: No relevant relationships by Chhabilal Bastola No relevant relationships by Sushma Edara No relevant relationships by Danilo Enriquez No relevant relationships by Nabin K C No relevant relationships by Ambika Devi Kaphle Bastola" @default.
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• W4387248520 date "2023-10-01" @default.
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• W4387248520 title "MYCOPLASMA INDUCED SJS/TEN EVOLVING INTO ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS (AGEP) WITH GI BLEEDING AND LIMITED MUCOSAL INVOLVEMENT" @default.
• W4387248520 doi "https://doi.org/10.1016/j.chest.2023.07.1885" @default.
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