Erythropoietin Induced Atypical Erythema Multiforme in a patient with chronic kidney disease- a rare presentation
Abstract
Introduction: Erythema multiforme is a hypersensitivity reaction to different antigenic stimuli, mostly due to infections followed by drugs. Erythropoietin Induced Erythema Multiforme is one of the rarest serious adverse effects seen till date.
Case Presentation: The patient was a case of Anaemia in Chronic Kidney disease and was advised Inj Erythropoietin 4000 IU, subcutaneously after every 15 days. After taking 2nd dose of Inj Erythropoietin, the patient developed erythematous polymorphous eruptions over palms, hands, abdomen. Following which the patient developed fever and athralgia. A diagnosis of Erythropoietin Induced Erythema Multiforme was made. Patient recovered completely over few weeks. The adverse event was reported to the regional Pharmacovigilance Centre.
Management: Erythropoesis Stimulating Agents (ESA) are used to treat anaemia in Chronic Kidney Disease. Drug Induced Erythema Multiforme is a delayed Type IV hypersensitivity reaction, associated with prodromal symptoms such as Fever, cough, difficulty in breathing, joint pain and swelling. Patient improves with IV corticosteroids, antihistamines and emollients.
Conclusion: Erythropoietin should be offered meticulously in patients with anaemia in CKD, considering its benefit in terms of quality of life and physical function. Extreme caution to be taken while prescribing Erythropoietin therapy in patients with history of stroke, or any hypersensitivity reaction.
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