SJS is diagnosed, but not quickly
AFTER MULTIPLE HOSPITAL VISITS FOR A RASH, a 34-year-old man was sent to a regional medical center for treatment. The rash was eventually diagnosed as a reaction to allopurinol, a potential side effect that was prominently noted in the drug warnings.
The patient developed Stevens-Johnson syndrome. He recovered after several days in the intensive care unit and was discharged with mild scarring over 80% of his body.
PLAINTIFF’S CLAIM The defendants negligently failed to diagnose a drug reaction after multiple reports of a known side effect.
DOCTORS’ DEFENSE Rashes are a common complaint in an emergency room; delayed withdrawal of the drug caused no additional harm.
VERDICT $72,500 South Carolina settlement.
COMMENT Although instances are rare, failure to diagnose and treat a dermatologic problem promptly can have catastrophic results. Stevens-Johnson syndrome needs to be included in the differential diagnosis of drug reactions and must be handled promptly. (See “Derm diagnoses you can’t afford to miss”.)
Lithium unmonitored, kidney failure followed
A WOMAN WAS STARTED ON LITHIUM, but the doctor who wrote the prescription never ordered follow-up blood tests for creatinine levels. When her blood was tested 7 years later by another physician for another medical problem, her creatinine levels were high.
The physician sent the woman to a nephrologist, who discontinued the lithium. Three years later the patient went into renal failure. She received a kidney transplant from her sister. The patient, 39 years of age, will have to take antirejection medication for the rest of her life. The plaintiff sued the doctor who wrote the original prescription as well as 2 other physicians who treated her.
PLAINTIFF’S CLAIM The 2 physicians who treated her saw blood test results showing a rise in creatinine, which should have prompted them to act.
DOCTORS’ DEFENSE No information about the doctors’ defense is available.
VERDICT $2 million New Jersey settlement.
COMMENT Certain medications, such as lithium, require careful and frequent monitoring. Although such surveillance is seldom evidence-based, this is probably one of those times when covering yourself is a guiding precept.