II. Signs

  1. Onset 15-40 days (2-6 weeks) after offending medication exposure
  2. Skin findings
    1. Similar initial Morbilliform rash as with Fixed Drug Eruption
    2. Periorbital edema
    3. Swelling
    4. Follicular prominence
  3. Systemic findings
    1. Fever
    2. Lymphadenopathy

III. Causes

  1. Anticonvulsants (most common)
  2. Sulfonamide antibiotics
  3. Allopurinol

IV. Labs

  1. Complete Blood Count
    1. Leukocytosis
    2. Eosinophilia
  2. Comprehensive metabolic panel
    1. Renal Insufficiency
    2. Transaminitis (increased AST and ALT)

V. Differential Diagnosis

  1. Fixed Drug Eruption
    1. Typically <2 weeks after exposure

VI. Management

  1. High-dose Corticosteroids tapered over months

VII. Complications

  1. Nephritis
  2. Arthritis
  3. Myositis
  4. Encephalitis
  5. Liver failure

VIII. Prognosis

  1. Mortality approaches 10% (due to fulminant hepatic failure)

IX. References

  1. Jhun and DeClerck in Herbert (2015) EM:Rap 15(2): 9-11

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