August/September 1999


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A. B. C.

 



 History: A 20 year old black female presented to the Barnes-Jewish emergency room with a chief complaint of painful sores in her mouth. She also complained of facial swelling, eye pain, a skin rash and skin tenderness. She had no known drug allergies and no significant prior medical history. Her only current medication was trimethoprim/sulfamethoxazole, prescribed 2 years prior to admission for acne.

Physical Examination: On presentation she was tachycardic (127 bpm) and febrile (38'C). She had edematous and vesiculated erythematous plaques and erosions on her face (Fig. A), chest, abdomen and on the extremities (Figs. B & C). There were extensive oral ulcerations and her lips were coated with a hemorrhagic crust. Her selerae were injected and her conjunctivae were red and edematous. She had a positive Nikolsky sign and exquisite skin tenderness.


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