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Stevens-Johnson syndrome/toxic epidermal necrolysis — SCE Acute Medicine MCQ

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HardAcute Rheumatological/Dermatological EmergenciesStevens-Johnson syndrome/toxic epidermal necrolysisSCE Acute Medicine

A 44-year-old woman started lamotrigine three weeks ago and now presents with fever, painful targetoid rash, oral erosions and conjunctivitis. Nikolsky sign is positive and approximately 12% body surface area has epidermal detachment. What is the most appropriate next step in management?

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Correct answer: A — Withdraw lamotrigine and transfer for specialist supportive care

Painful targetoid lesions, mucositis and 12% epidermal detachment after lamotrigine indicate SJS/TEN overlap. Stop the culprit immediately and transfer for specialist multidisciplinary supportive care, including fluid, temperature, ocular, genital and infection management. Drug provocation or acute allergy testing is unsafe.

Reference: https://academic.oup.com/bjd/article/174/6/1194/6617016