Case Report D.Choe 1/20/16

History 32F with history of depressive symptoms, bipolar disorder, pw itchy and now painful rash for approx 1 week, worsening in past two days Started on Amoxicillin 6 days prior for “strep” Seen at urgent care clinic 4 days prior, discharged with prednisone, pepcid, benadryl Seen here 2d prior for similar complaint, requested discharged after improvement with allergy meds

History Reports rash located “everywhere,” accompanied by persistent sore throat, blurry vision Painful upper extremities

Physical Symmetrical, generalized papular rash coalesced into macules on the b/l upper extremities with overlying blisters Painful to palpation of upper extremities

Physical Symmetrical, generalized papular rash coalesced into macules on the b/l upper extremities with overlying blisters Painful to palpation of upper extremities HEENT: multiple areas of oral lesions <1cm each on inner surface of lips, soft palate; Diffuse conjunctival injection b/l, hesitant to open eyes completely secondary to pain Denies vaginal involvement

Physical TBSA of desquamation approx 2-5%

Physical TBSA of desquamation approx 2-5% SJS

Medications Seroquel Propranolol Prednisone Benadryl Lamotrigene

Causes Allopurinol Aromatic anticonvulsants Antibacterial sulfonamides Lamotrigene Nevirapine Oxicam NSAIDS

Predisposing Factors HIV Lupus Malignancies