History: 41 year old African American female with a history of seizure disorder presented to Barnes Jewish Hospital complaining of facial swelling, subjective fevers and new onset rash approximately 3 weeks after increasing her dose of phenytoin.
Past Medical History: Seizure disorder on anti-epileptics (Phenytoin) recently increased and recent hospitalization for submandibular cellulitis taking clindamycin
Medications: Phenytoin and Clindamycin
Allergies: No known drug allergies
Physical Exam: Erythematous maculo-papular eruption on trunk and extremities (Fig.1); marked facial swelling and scaling (Fig.2; anterior cervical and submandibular lymphadenopathy
Laboratory data: WBC count: 21.1, with 13% eosinophils; Elevated AST (85), and ALT (88).
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