(BMJ) - A 54-yo man w/alcoholism, neuropathy, vocal cord cancer s/p recent radiotherapy on prednisolone, fentanyl, antidepressants was given amoxicillin for sore throat. Five days later he had fever, rash; multiple organ failure ensued. Skin exfoliated upon touch.
Stevens-Johnson/Toxic epidermal necrolysis
Acute cutaneous radiation injury
Erythema multiforme major
Acute graft vs. host disease
Alcohol-induced porphyria (PCT)
You are correct. Nikolsky’s sign (epidermis separation on touch) affects <10% of body surface in SJS, >30% in TEN. This patient had about 20%, qualifying as SJS-TEN overlap. He recovered from a 26-day ICU stay; 6 months later, he had dry eyes and torso dyspigmentation.
(BMJ) - A 9-yo girl w/ painful scalp lesion noted a small, erythematous, scaly, pruritic eruption that increased over 6 wks despite antibiotics. Exam: Afebrile, well-appearing, boggy inflammatory mass on her crown, localized alopecia, + cervical LN. What is it?
Folliculitis decalvans
Acne keloidalis nuchae
Alopecia areata incognita
Tinea capitis (ringworm) kerion
Plaque psoriasis
You are correct. A fungal kerion is an inflammatory reaction to tinea capitis. She was treated with oral griseofulvin and ketoconazole shampoo x 2 months and made an excellent recovery.