Figure 1

Figure 2

"Skin Rash and Sore Throat"

Moustafa H, Moustafa, M.D. and Leon Salem, M.D.,M.S.

A 40-year-old male presents to the emergency department complaining of a three-day history of a "body rash" productive cough, sore throat, maliase and diarrhea. The rash originated on the trunk and progressed to the extremities and face. Past medical history includes schizophrenia for which he was recently switched from chlopromazine to carbamezpine two weeks prior.

Physical Examination
Blood Pressure 136/160, Pulse 110, Respirations 20. Temperature 101.2F
The patient presented alert, fully oriented, cooperative and in no acute distress. A generalized erythematous macular rash with areas of petichiae was noted (Figure 1 and 2). Bilateral conjunctival injection was present and dried blisters were noted on the lips and oral mucosa (Figure 1). The palms revealed erythematous plaques with dusky centers and bright borders resembling the 'bulls eye' of a target (Figure 3). The soles showed a similar eruption with hemorrhagic bullae (Figure 4). There was no nuchal rigidity. The remainder of the physical examination was unremarkable.

Laboratory and Radiographic Studies
CBC, electrolytes and spinal fluid analysis were normal. VDRL was non-reactive.
Chest x-ay and non-contrast CT of the head revealed no abnormalities.

ANSWER