You introduce yourself to Mr. Magoro and his wife who is at the bedside, and they politely return the greeting. He tells you that over the last week, his skin has become very red, itchy, and warm to the touch. The rash originated on his abdomen, then progressed over the course of a few days to cover his entire body. He has not been able to find any section of skin that has not been affected. Mr. Magoro tells you that over the last 24 hours, he has begun to feel very weak, tired, and feverish, almost as if he “had the flu”. His wife called EHS this evening when Mr. Magoro was unable to climb the stairs to the entrance of their townhouse, complaining that he “just didn’t have the strength to get there.” You screen him for signs and symptoms of Steven-Johnson Syndrome and Toxic Epidermal Necrolysis, namely skin pain, eye symptoms, mouth soreness, and genital lesions. Thankfully, he denies all of these.
Considering Mr. Magoro’s level of distress and discomfort, you decide to check his vital signs and complete a relevant physical exam to make sure he is stable before asking more questions. You find the following:
- Appearance: erythematous to violaceous skin, slightly diaphoretic, tachypneic, distressed
- Vitals: BP 95/65, HR 112, RR 26, SaO2 96% on RA, temp 37.8oC
- HEENT: prominent facial edema especially around the eyes,no cervical lymphadenopathy, mucosal membrane intact
- Cardiovascular: tachycardic but normal heart sounds, no murmurs, pedal pulses palpable x 4, extremities warm, JVP 1cm ASA, 2+ pedal edema to the mid-shins bilaterally
- Respiratory: trachea midline, tachypneic, equal air entry bilaterally, no crackles or wheeze
- Abdomen: normal bowel sounds, no abdominal tenderness, slight ascites on fluid wave test, mild hepatosplenomegaly
- Neurologic: alert and oriented x 3, no focal neurologic deficits noted
- Dermatologic: negative Nikolsky sign
Based on the history and your physical exam findings, you become concerned that Mr. Magoro may destabilize if corrective measures are not taken immediately.
