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Stevens-Johnson syndrome — RACP Paediatrics MCQ

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HardRheumatology and dermatologyStevens-Johnson syndromeRACP Paediatrics

A 10-year-old treated with lamotrigine develops fever, painful targetoid rash, oral erosions and conjunctivitis. Nikolsky sign is present and there is early skin detachment. What is the most likely cause?

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Correct answer: E — Severe cutaneous adverse drug reaction

Painful mucositis, targetoid lesions and skin detachment after a high-risk medicine suggest Stevens-Johnson syndrome or toxic epidermal necrolysis spectrum. Scarlet fever causes sandpaper rash rather than mucosal erosions and epidermal detachment. Immediate drug cessation and specialist supportive care are critical.

Reference: RACP Knowledge Guides; Therapeutic Guidelines (eTG)