March 2012




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).

Click here for the Diagnosis.