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Stevens-Johnson syndrome — MCCQE Part 1 MCQ

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HardRashStevens-Johnson syndromeMCCQE Part 1

30-year-old woman presents with painful rash after starting lamotrigine. She has fever, targetoid lesions and oral erosions. Which of the following is the most appropriate next step?

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Correct answer: C — Stop the culprit drug, admit and involve dermatology/burns/ophthalmology

Stop the culprit drug, admit and involve dermatology/burns/ophthalmology is best because mucosal erosions and systemic symptoms suggest SJS/TEN spectrum. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Early drug cessation is critical.

Reference: Canadian dermatology guidance