skip to main content

Stevens-Johnson syndrome — RACP Paediatrics MCQ

Instant feedback + full explanation. One question, done properly.

HardRheumatology and dermatologyStevens-Johnson syndromeRACP Paediatrics

A 12-year-old started lamotrigine three weeks ago and now has fever, painful widespread dusky macules, oral erosions and conjunctivitis. Nikolsky sign is present over small areas. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Stop lamotrigine and admit for supportive care with dermatology and ophthalmology input

Mucosal erosions, fever and dusky targetoid lesions after a high-risk drug suggest Stevens-Johnson syndrome; the culprit drug must be stopped and the child admitted for supportive multidisciplinary care. Anaphylaxis causes acute urticaria/angioedema rather than progressive mucocutaneous necrosis. The pearl is that early ophthalmology involvement can reduce long-term ocular morbidity.

Reference: RCH Clinical Practice Guidelines; Therapeutic Guidelines (eTG): Dermatology