Just the facts: diagnosis and management of Stevens–Johnson syndrome/toxic epidermal necrolysis

Clinical scenarioA 70-year-old male presented to the ED with a 3-day history of fever, sore throat, and myalgia.Vital signs were notable for a temperature of 38.6 C, heart rate of 110 beats per minute, blood pressure of 100/60 mmHg, and oxygen saturation of 95% on room air.The patient's laboratory values were largely within normal limits: white blood cell count 10.1 10/L, creatinine 50 mol/L, urea 3.8 mmol/L, fasting glucose 5.0 mmol/L, aspartate aminotransferase 35 U/L, and alanine aminotransferase 29 U/L.C-reactive protein was elevated at 30 mg/L.Immunoglobulin levels were within reference ranges.Physical examination revealed erythematous plaques, bullae, and epidermal sloughing involving 8% of total body surface area including the trunk and limbs.Several erosions were also noted inside the buccal mucosa.The patient was diagnosed with hyperuricemia 4 weeks ago and was prescribed oral allopurinol 300 mg qd.