A 35-year-old patient comes to clinic because he has a worsening rash. He has had a rash in the past on his elbows and knees, but after finishing a “steroid pill” for his asthma his rash suddenly got worse. He also repos fevers and chills. On examination he has erythema involving 90% of his body surface area and there are some small pustules on top of the erythema on his trunk. What his the diagnosis?
Correct Answer: TEN
Description: Bullous disease secondary to the ingestion of drugs can take one of several forms, : Phototoxic eruptions, Isolated bullae, Stevens-Johnson syndrome (SJS), Toxic epidermal necrolysis (TEN)- Erythema progressing to bullae with resulting sloughing of the entire thickness of the epidermis occurs in toxic epidermal necrolysis. Causes- Sulfonamides, phenytoin, barbiturates, lamotrigine, aminopenicillins, nonnucleoside reverse transcriptase inhibitors (e.g., nevirapine), and carbamazepine. Widespread dusky macules and significant mucosal involvement are characteristic of SJS, and the cutaneous lesions may or may not develop epidermal detachment. If the latter occurs, by definition, it is limited to <10% of the body surface area (BSA). Greater involvement leads to the diagnosis of SJS/TEN overlap (10-30% BSA) or TEN (>30% BSA).
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