Monday, February 11, 2008

Not for the Faint of Heart

You get an emergency consult as an infectious disease doctor. A 25 year old girl had presented with high fever and severe headache. She was throwing up every few hours and had trouble moving her neck. She avoided light and sound and acted confused and lethargic. She was treated a week ago, but came in today with a severe rash. She said she felt feverish earlier with sore throat, cough, and malaise.

You look closely at her. It looks like you can peel away the top layer of skin from the lower layers. It's almost as if she's been severely burned. You notice blisters and erosions in her mouth. She says, "I can't eat, my eyes hurt, it hurts when I pee..." Indeed, this rash covers her eyes, her mouth, and vagina.

Challenge: What is the diagnosis?

Related Questions:
1. When she originally presented to the doctor, what did she have?
2. What is the cause of her current condition?

Image shown under fair use.

1 comment:

Craig said...

Not for the Faint of Heart

The patient originally presented with symptoms of meningitis (triad of fever, mental status changes, and nuccal rigidity), and she was given antibiotics. This current presentation is a response to those medications. The symptoms of an upper respiratory tract infection before appearance of this rash suggests Stevens-Johnson syndrome or Toxic Epidermal Necrolysis (the more severe form). This is a life-threatening drug-induced dermatologic condition with rapid onset erythematous or purpuric macules and plaques progressing to epidermal necrosis and sloughing; mucosal membranes are often involved. Skin pain may be out of proportion to the findings. The drugs most implicated are antibiotics (sulfa, penicillin), antiepileptics, and NSAIDs.

Sources: Wikipedia, eMedicine, Medical Journal of Australia, UpToDate.