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Issue: November 1, 2006
Case: Dermatology Quick Case
Taken from
Med-Challenger EM Career
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Question:
What disorder can cause a morbilliform rash
progressing to vesicles and bullae with widespread denudation of
the epidermis, accompanied by fever, malaise and arthralgias?
Give the cause and mortality.
Answer Options:
- Erythema multiforme due to herpes simplex virus; good prognosis with low
mortality.
- Drug-associated toxic epidermal necrolysis, with cleavage at the dermo-epidermal
junction; roughly 25% mortality.
- Viral or fungal infection-induced epidermal necrolysis, with intradermal
cleavage; roughly 65% mortality.
Answer:
B
Remediation:
Toxic epidermal
necrolysis (TEN) is usually caused by drugs, and less commonly
by infection (most commonly mycoplasma). TEN may represent a
severe form of Stevens-Johnson syndrome.
Toxic shock presents with desquamating erythema due to
staphylococcal infection. A similar syndrome can result from
severe streptococcal infection.
True classic erythema multiforme is now considered to be mostly
caused by subclinical or clinical herpes simplex virus
infection. True classic erythema multiforme, while sharing many
clinical and histologic features, may no longer be considered
nosologically related to TEN and Stevens-Johnson syndrome.
About the Image(s):
Image 1:
Toxic Epidermal Necrolysis
from Phenytoin
Toxic epidermal necrolysis consists of confluent
blistering with subsequent denudation that covers a majority of
the skin surface, as has occurred in this patient who is
allergic to phenytoin.
Image 2: Toxic Epidermal
Necrolysis from Allopurinol
This patient developed toxic epidermal necrolysis as a result of
allopurinol therapy, and the resulting fluid loss and infection
was fatal.
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