N Jagirdar

References Stevens M, Johnson FC. A new eruptive fever associated with stomatitis and ophthalmia; report of two cases in children. American Journal of Diseases of Children 1922; 24: 526–533. 2 Paul C, Wolkenstein P, Adle H, et al. Apoptosis as a mechanism of keratinocyte death in toxic epidermal necrolysis. Br J Dermatol 1996; 134(4): 710–4. 3 Gravante G, Delogu D, Marianetti M, et al. Toxic epidermal necrolysis and Steven Johnson syndrome: 11-years experience and outcome. Eur Rev Med Pharmacol Sci 2007; 11(2): 119–27. 4 Chang YS, Huang FC, Tseng SH, et al. Erythema multiforme, StevensJohnson syndrome, and toxic epidermal necrolysis: acute ocular manifestations, causes, and management. Cornea 2007; 26(2): 123–9. Full Text File size: 95 KB Downloads: 455...

A fifty-one-year-old man with history of treated hypertension and seronegative rheumatoid arthritis presented to hospital with a three day history of a rash affecting the whole body and general malaise. He had been commenced on sulfasalazine 2 weeks ago to control his rheumatoid arthritis, which the patient had discontinued taking three days prior to admission.

On examination, he was comfortable with a temperature of 39oC and a widespread erythematous maculopapular rash. Investigations revealed a normal FBC, UEs, LFTs but high inflammatory markers with a CRP 125.9 and ESR 52.

One day later the patient developed odynophagia and blisters on his lips and mouth shown in the picture below (Figure 1 and 2).