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

A 42-year-old man presents to the emergency department for evaluation of a painful, rapidly-spreading rash involving his trunk, extremities, and face that started 24 hours ago. The patient reports preceding symptoms of fever and malaise. He states the rash started on his face and chest yesterday and that today the rash extended to his back and all extremities; he also developed lesions in his mouth. He has a past medical history of obesity, hypertension treated with amlodipine, and gout for which allopurinol was started one month prior. The patient returned from an uncomplicated medical mission trip to South America three months ago. Temperature is 37.5°C (99.5°F), blood pressure is 112/60 mmHg, pulse is 104/min, respiratory rate is 18/min, and oxygen saturation is 97% on room air. On skin examination, the patient has extensive dusky erythema, flaccid bullae, and painful erythema of the palms and soles bilaterally. He has bilateral conjunctival erythema. Findings from the oral exam are seen below. Cardiopulmonary examination is within normal limits. Which of the following most likely contributed to the development of the underlying condition?



  Reproduced from: wikipedia