Case Description
A 23-year-old female patient who was commenced on sulfasalazine and
hydroxychloroquine five weeks ago for a newly diagnosed seronegative
rheumatoid arthritis presented for evaluation of a 10-day history of
progressive skin rash, which initially started on her trunk and spread
peripherally to her extremities, neck, and face. She stopped her
medications since the onset of the rash; however, her facial swelling
and redness had increased over the past few days before the
presentation. She also reported subjective fever, chills, dry cough, and
joint pains in the lower extremities.
On examination, she was feverish with a temperature of 103 °F,
tachycardic with a heart rate of 110 beats per minute, a blood pressure
of 100/60 mmHg, tachypneic with a respiratory rate of 25 per minute, and
an oxygen saturation of 90% at room air. Cervical lymphadenopathy and
hepatosplenomegaly were noted. Skin examination revealed widespread
erythematous morbilliform eruptions distributed on the trunk and
extremities, including palms and soles, covering approximately 80 % of
the total body surface area (TBSA) with follicular accentuation on the
lower extremities. Confluent erythema of the face with facial edema with
multiple discrete perifollicular pustules were observed along the
frontal hairline and throughout the scalp. No oral or vaginal mucosal
involvement or desquamation was observed. (Figure 1 Panel A-C). The lung
examination was unremarkable, but a stridor was noted, for which she was
intubated for airway protection.