A 60-year-old man on carbamazepine treatment for epilepsy presenting with fever (38.8°C), odynophagia, conjunctivitis, brownish skin lesions spread over a large body surface, target-like in appearance and accompanied by epidermal detachment (greater than 30%) at the slightest friction. It is very likely that she is presenting a clinical picture of:
We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area. Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4). If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson (and intermediate cases are referred to as overlap, since it is a whole spectrum). Incidentally, we would recommend immediate admission to a major burn unit.
Acute urticaria of pharmacological cause.
Erythema minor exudative secondary to drugs.
Pharmacological Stevens-Johnson syndrome.
Epidermal toxic necrolysis.
If the epidermal detachment is less than 10% then we would be dealing with Stevens-Johnson
We are dealing with a severe patient, with target lesions and Nikolsky's sign in > 30% of the body surface area. Together with the history of treatment with carbamazepine, the suspicion will be of toxic epidermal necrolysis (answer 4).