A 14 year old girl is admitted to the Infectious Disease unit with fever, a dry cough, red eyes, crusted lips and a skin rash which affects her palms, soles and extensor surfaces of arms and legs. She felt increasingly unwell for 3 days prior to admission with lethargy and myalgia. She is finding it very painful to eat and drink.
She is usually fit and well and is on no regular medication. The only medication she has taken is paracetemol, and she’s not sure whether the rash was present before she took this.
She lives in the UK and last visited her maternal relatives in Bangladesh 5 years ago.
Temp: 37.6 BP: 117/60 Pulse: 88 Oxygen sats: 92% on air RR: 18
General examination: Looks miserable and generally unwell. Erythema of the skin around both eyes, with bilateral conjunctival injection. Haemmorhagic crusting of upper and lower vermillion lips (patient declined permission to use photographs of her face). Shallow ulceration of buccal and palatal mucosae.
Examination of chest and abdomen reveals no obvious abnormality.
- Can you describe the rash?
- What diagnoses would you consider at this point, and which is most likely?
- What further tests would you order?
Many thanks to Dr Ann Sergeant, Dermatology Consultant, for our first case of 2013.
Students, let us know what you think on the class discussion boards.