This document presents a case report of a 40-year-old male patient presenting with red, raised, scaly lesions all over his body for 15 days. The patient has a history of pulmonary tuberculosis and was taking antitubercular drugs for 2 months before developing the lesions. On examination, the patient has multiple erythematous, scaly plaques and papules with some crusty lesions on the palms and soles. Laboratory investigations show normocytic normochromic anemia and normal renal and liver function tests. The patient is assessed to have drug-induced erythema multiforme likely caused by the antitubercular drugs. He is prescribed medications to treat the condition and relieve symptoms along with lifestyle advice

1. CASE PRESENTATION
ON
ERYTHEMA LESSIONS
BY
SALMA TASNEEM (Pharm-d 5th year)
MESCO COLLEGE OF PHARMACY

2. SUBJECTIVE
 Name of patient:H.Venkataiah
Age:40 IPNO:170459
DOA:6/4/15
Dept :DVL
Complaints:red raised scaly lesions;15days
but flare up of lesions;7days.
itching over the lesions.

3. History of present illiness: Patient was apparently asymptomatic 15 yrs
back,then he noticed red raised scaly lessions initially started as
papule,later progrssed to pastules plaques and erusions since 1months
to invole forearm arm then both lower limbs, abdomen face and scalp.
h/o waxing and wanning of lesions aggregating during summer.
Subsuiding with treatment.

4.  DRUG HISTORY :complaints of pulmonary TB Since 3months.
He has taken ATT Drugs for 2months and stopped. Since 1months
because of developing these lesions.
H/o fever
H/o diarrhoea
Sore throat ; since 1month of developing lesions.
PAST HISTORY: Known Diabetic :3yrs on Rx

5. OBJECTIVE
 Pt c/c/c
pedal edema.
Afebrile.
PR:82/min.
BP:120/80mmhg.
Hb:13.5gm/dl
WBC Count: 3,200
N: 67
L:28
M:03

6.  E:02
Platelets: markedly platelets
BP:Normo cytic; Normochromic
ESR:15mm
RBS: 168
S.Urea:24
S.Creatinine:0.8
Serum Electrolytes:Na:131
K:4.4
Serum Total Bilibirubin :0.9

7.  URINE EXAMINATION:
Colour :yellow
Albumin: Trace
Sugar :Nill
Pus cells: 1-2 HPF
Epithelial cells : 1-2 HPF
CUTANEOUS EXAMINATION: Multiple erythematous Scaly
plaques ; papules errosions present all over the
body.some crusty lessions also present over palms soles .

8. ASSESMENT
 Based on the investigations done it is drug induced erythema
lessions.

9. Drug
brand
name
Generic
name
Indication Dose Route of
administrati
on
Frequency
Inj.monoc
ef
Ceftriaxone Antibiotic 1gm IV BD
Inj.Rantac Ranitidine Antacid 50mg IV BD
Cap Aand
D
T.BC
B.COMPLEX
Vitamin
supplement
Oral BD
Liquid
paraffin
White soft
paraffin
Cream Topical OD
T.PCM Paracetamol Analgesic 500mg oral OD
High
protein
diet
.

10. Patient counselling regarding disease
medication
 Erythema multiforme (EM) is an acute, self-limited, and sometimes
recurring skin condition considered to be a hypersensitivity reaction
associated with certain infections and medications. A range of
medications can trigger the EM. Non-steroidal anti-inflammatory
drugs (NSAIDS) which are most commonly prescribed for pain
relief can also produce rare adverse reactions such as EM. EM is
clinically characterized by a ‘‘minor’’ form and a ‘‘major’’ form.
Only few reports have stated about oral EM as the third variant of
EM.

11. Patient counselling regarding
medication
 Monocef: Ceftriaxone is a third-generation cephalosporin antibiotic.
Like other third-generation cephalosporins, it has broad spectrum
activity against Gram positive and Gram negative bacteria. In most
cases, it is considered to be equivalent to cefotaxime in terms of
safety and efficacy.
 Adverse effects: Eosinophilia,thrombocytosis,diarrhea,rash.
 Rantac: Rnatac is a histamine H2-receptor antagonist that inhibits
stomach acid production. It is commonly used in treatment of peptic
ulcer disease and gastroesophageal reflux disease. Ranitidine is also
used alongside fexofenadine and other antihistamines for the
treatment of skin conditions such as hives.
 Adverse effects:Abdominal pain,agitation,alopecia,confusion.

12. Regarding life style modification
Minimize sun exposure. Ultraviolet light may
trigger new blisters
Ask your doctor if you need calcium and
vitamin D supplements. Corticosteroids can
affect your calcium and vitamin D needs, so ask
your doctor if you need a calcium supplement
or any other additional nutrients.
To ease discomfort, treat sores and blisters with
soothing or drying lotions or wet dressings.

13. THANK YOU