10:18| This CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITAL describes a 10-year-old girl who was transferred to the Shriners Hospital for Children in Boston because of a bullous skin eruption, with sloughing of the skin and respiratory failure.
The patient had been well until two months before admission, when she had a generalized tonic–clonic seizure. She was examined at different hospital and treated with diazepam.
One month before admission, during an episode of gastroenteritis, intermittent twitching occurred in both legs. A diagnosis of seizure was made, and a neurologist prescribed carbamazepine.
On examination two days after the seizure, the physical and neurologic examinations showed no abnormalities.
Nine days later, the temperature rose and a rash appeared on the patient's trunk. The next day she went to the emergency room of the hospital where she had been treated previously. A diffuse, erythematous morbilliform rash with extensive confluence was present, most intensely visible on the back, trunk, and upper arms and thighs, with blanching. A diagnosis of hypersensitivity reaction was made. The carbamazepine was discontinued. The patient was discharged to her home.
The next day, the rash had spread to involve most of her body, and vesicles had developed. On examination, diffuse, erythematous, raised lesions involved the face, trunk, back, arms and legs, and lips. Nikolsky's sign that is ready removal of the epidermis with slight tangential pressure was present.
This case record describes ??? After a protracted course of management in the burn unit, reepithelialization occurred, and the patient fully recovered.
Dr. Vincent Liu discusses differential diagnosis of blistering skin eruption. [Original Article]
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