SJS from Lamotrigine — RACP Adult Medicine MCQ

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HardDermatologySJS from LamotrigineRACP Adult Medicine

A 58-year-old develops lamotrigine-associated epidermal detachment over 8% of body surface area with mucosal erosions. Heart rate is 126/min, urea 12 mmol/L, bicarbonate 18 mmol/L and glucose 9 mmol/L; there is no malignancy. What is the SCORTEN at presentation?

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Reveal the answer and explanation

Correct answer: B — 4

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

A is correct: age over 40, heart rate over 120/min, urea over 10 mmol/L and bicarbonate under 20 mmol/L each score one point. B omits two present variables. C omits one present variable. D incorrectly scores detachment below 10% or another absent criterion. E would require two additional criteria, such as malignancy, glucose over 14 mmol/L or detachment over 10%. SCORTEN complements urgent drug withdrawal and specialist supportive care; it does not delay transfer.

Reference: NSW Agency for Clinical Innovation, Statewide Burn Injury Service clinical resources: https://aci.health.nsw.gov.au/networks/burn-injury/clinical; DermNet, Stevens–Johnson syndrome and toxic epidermal necrolysis: https://dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis