Stevens-Johnson syndrome and toxic epidermal necrolysis Quiz: Ace Your Exams

A 67-year-old woman presents to the emergency department for evaluation of a painful desquamating rash that has developed over the past two days. The patient reports preceding symptoms of fever, malaise, and nausea. The rash began on her face but now involves her arms, mouth, chest, and back. The patient has a past medical history of HIV, is prescribed antiretroviral therapy, and has had several recent medication changes—including the initiation of nevirapine. Temperature is 38°C (100.4°F), blood pressure is 107/60 mmHg, pulse is 105/min, respiratory rate is 16/min, and oxygen saturation is 97% on room air. On physical examination, the patient has multiple areas of dusky erythema, purpura, and flaccid bullae over her arms, chest, and back, and face. She has ulcerative lesions in the oropharynx. Skin biopsy is performed, which reveals full-thickness necrolysis and separation of the epidermis at the dermo-epidermal junction. In addition to discontinuing nevirapine, which of the following is the most appropriate next step in management?