A 62 year old man appear a history of alternate articulate ulcers, sometimes with laryngitis, and conjunctivitis. He consulted his doctor in 2011 for astute access agitation (39°C), odynophagia, and laryngitis abiding two days, and was assigned ibuprofen and clarithromycin. Two canicule later, conjunctivitis, articulate close film erosions, and cutaneous lesions appeared. The accommodating was hospitalised on suspicion of Stevens-Johnson syndrome.
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Dermatological assay showed several ambition lesions on the trunk, lower limbs, and scrotum (fig 1, 2⇓), conjunctivitis (fig 3⇓), and broadcast erosions of the close membranes involving the aperture (palate, tongue, buccal mucosa, and lips) (fig 4⇓), and glans. Assay of ear, nose, and throat showed broadcast nasal erosion, crusts, and epiglottal erosion. The accommodating had no dysuria, affliction with defecation, or pulmonary symptoms. His accepted action was poor, with fever, fatigue, and adversity eating.
Fig 1 Disseminated ambition lesions
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Fig 2 Eye captivation with conjunctivitis
Fig 3 Lip and argot erosions
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Fig 4 Lesions with three rings
Blood assay showed accustomed claret corpuscle counts, added C acknowledging protein (160 mg/L), abrogating canker canker virus ability from the aperture and skin, and abrogating HIV, canker canker virus, Mycoplasma pneumoniae, and Chlamydia pneumoniae serologies. Bark biopsy showed a close lichenoid lymphocytic access with baleful keratinocytes in the basal layer. Direct and aberrant immunofluorescence tests were both negative.
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1. What is the analysis and what analytic allegation advance this?
2. What cogwheel analysis needs to be afar afore chief whether the accommodating can use ibuprofen and clarithromycin in the future?
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3. When should patients with this action be referred to the dermatologist and what is the treatment?
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