The conjunctivae, lips, and buccal mucosa were also involved, showing edema and erosions. Examination of the chest revealed no abnormal sounds. The hematocrit reading was 43.2 percent, the white blood cell count was 5,200/cu mm, and the platelet count was 92,000/cu mm. The activated partial thromboplastin time was prolonged to 101.7 s. The serum level of fibrinogen degradation product was 80fJLg/nil to 160|ig/ml, suggesting the presence of disseminated intravascular coagulation. Arterial blood gas analysis revealed a PaCo2 of 26.3 mm Hg and a Pa02 of 53.8 mm llg (room air). The chest roentgenogram showed relatively clear lung fields. buy levaquin online
The patient was treated on an air cushion bed usually used for nursing patients with burns and received heparin, gabexate mesi-late, antibiotics, and steroids intravenously. Arterial blood gas values improved to a PaO, of 73.9 mm Hg and a PaCo, of 35.7 mm Hg on room air by the tenth day in the hospital, together with normalization of the platelet count and the activated partial thromboplastin test. The cutaneous lesions also improved, clearing from the conjunctival and oral areas by the 12th day in the hospital, so the patient was transferred to the dermatology ward.
Twelve days later, the patient developed wheezing and gradually progressive dyspnea. A chest roentgenogram revealed slightly hyperinflated lungs without any evidence of infiltrative lesions (Fig 1).
Figure 1. Anteroposterior view of chest, showing slightly hyperinflated lungs with no significant opacities. Roentgenogram was taken 24 days after onset of Stevens-Johnson syndrome when progressive dyspnea developed.