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Stevens-Johnson syndrome — SCE Acute Medicine MCQ

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ModerateAcute Rheumatological and Dermatological EmergenciesStevens-Johnson syndromeSCE Acute Medicine

A 41-year-old man is assessed on the acute medical unit. He develops fever, painful targetoid rash, oral erosions and conjunctivitis 10 days after starting lamotrigine. Skin is tender with early blistering. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most appropriate next step in management?

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Correct answer: E — Stop the suspected causative drug and resuscitate

Stop the suspected causative drug and resuscitate is the best answer because suspected SJS requires immediate withdrawal of the culprit drug and supportive specialist care. Start intravenous N-acetylcysteine promptly is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Mucosal involvement and skin pain distinguish SJS from simple exanthems.

Reference: BAD guideline; BNF