• DOI:10.1111/j.1468-3083.2007.02490.x
• Corpus ID: 12775035

Probable drug rash with eosinophilia and systemic symptoms syndrome related to tetrazepam

@article{Bachmeyer2008ProbableDR,
  title={Probable drug rash with eosinophilia and systemic symptoms syndrome related to tetrazepam},
  author={Claude Bachmeyer and Haudrey Assier and Jean Claude Roujeau and Laurent Blum},
  journal={Journal of the European Academy of Dermatology and Venereology},
  year={2008},
  volume={22}
}

• C. Bachmeyer, H. Assier, +1 author L. Blum
• Published 1 July 2008
• Medicine
• Journal of the European Academy of Dermatology and Venereology

© 2008 The Authors 887 JEADV 2008, 22, 875–903 Journal compilation © 2008 European Academy of Dermatology and Venereology with blood debris below a pillow and injection syringes containing a yellow-brown fluid, many other tools and a pouch of yellow fluid containing swollen beans that smelled very like faeces or something rotten in her bag (fig. 2). Pathologic examinations of the beans resembled those of the foreign materials observed in the skin biopsy specimen. Finally, the beans were proven to be fermented soybeans – ‘Natto’, which is a traditional side dish for boiled rice. The culture of yellow fluid grew similar bacterium to those of the pus and blood, and then, we concluded that the yellow fluid was a mixture of faeces and ‘Natto’. Despite repeated questioning, she denied self-injections of the foreign materials. Taken together, we made a diagnosis of Munchausen’s syndrome. After a commencement of intravenous antibiotics and vasopressor treatment, she rapidly became well, and no other new eruptions appeared by watching her movement in cooperation with her family. Clinical manifestations of Munchausen’s syndrome include ulcerations, abscess, nodular panniculitis and pyoderma gangrenosum Artefactual dermatitis can be caused by a variety of means, such as injection of drugs including morphine, faeces or urine, garlic, dyes and talc. A skin biopsy is often proved to useful in the diagnosis of artefactual dermatitis. We could prove that the dermatitis and septicemia were caused by faeces and ‘Natto’. Effective therapeutic drugs for these patients have not been described. We suggest that it is necessary to explain sufficiently the disease to the family and support the patient with a good doctor–patient–family relationship. Factitious dermatitis must be kept in mind when a patient presents a confusing clinical picture and has a foreign body reaction upon biopsy examinations and when the lesions do not tend to heal or repeatedly recur despite appropriate treatment. M Tochigi,* H Hara,*† J Goshima,† M Kobayashi,† H Shimizu,† A Yokoyama,† A Matsunaga,† T Takemura,‡ T Terui† †Department of Dermatology, Nihon University School of Medicine, Tokyo, Japan and ‡Department of Dermatology, Niiza-shiki Central General Hospital, Saitama, Japan, *Corresponding author, Department of Dermatology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173–8610, Japan. tel. [phone] (ext; 2502); fax [phone]; E-mail: [e-mail]