DRESS syndrome and severe cutaneous reactionsDownloads

A 10-year-old boy presents with a painful rash for 1 day. He says that the reddish, purple rash started on his forearm but has now spread to his abdomen. He says there is a burning pain in the area where the rash is located. He also says he has had a stuffy nose for several days. Past medical history is significant for asthma and epilepsy, medically managed. Current medications are a daily chewable multivitamin, albuterol, budesonide, and lamotrigine. On physical examination, there is a red-purple maculopapular rash present on upper extremities and torso. There are some blisters present over the rash, as shown in the image, which is also present in the oral mucosa. Which of the following is the most likely cause of this patient’s symptoms?

A 42-year-old man who is employed as a construction worker presents to his primary care physician with complaints of moderate headaches and profuse sweating. He reports the need to carry up to 3 additional shirt changes to work because they drench quickly even with tasks of low physical exertion. His coworkers have commented about his changing glove and boot sizes, which have increased at least 4 times since he joined the company 10 years ago. Physical examination is unremarkable except for blood pressure of 160/95 mm Hg, hyperhidrosis, noticeably large pores, hypertrichosis, widely spaced teeth, and prognathism. Which of the following best explains the patient’s clinical manifestations?