1st July 2023

A 24-year-old woman presents to ED with a rash, fever and shortness of breath. Her medical history includes a new diagnosis of epilepsy

A 24-year-old woman presents to ED with a rash, fever and shortness of breath. Her medical history includes a new diagnosis of epilepsy 7 weeks ago, for which she was started on carbamazepine. She takes no other medications. On examination, she has erythroderma, a widespread macular rash and facial swelling. There is palpable lymphadenopathy. Blood results were as follows:

• WCC 20 x 10⁹/L (4-11 x 10⁹/L)
• Haemoglobin 12 g/dL (11.5 – 16.5 g/dL)
• Platelets 450 x 10⁹/L (150-450 x 10⁹/L)
• Neutrophils 15 x 10⁹/L (2.2 -6.3 x 10⁹/L)
• Lymphocytes 2 x 10⁹/L (1.3 – 4 x 10⁹/L)
• Eosinophils 4 x 10⁹/L (0-0.4 x 10⁹/L)
• C-reactive protein 10 mg/L (<5 mg/L)
• Erythrocyte sedimentation rate 5 mm/hr (1-10mm/hr)
• Albumin 36 g/L (35-50 g/L)
• Alkaline phosphatase 200 IU/L (30-130 IU/L)
• Aspartate transaminase 150 IU/L (10-50 IU/L)
• Gamma glutamyl transferase 600 IU/L (1-55 IU/L)
• INR (international normalised ratio) 1 (0.9-1.2)

What is the most likely dermatological diagnosis?

Select the SINGLE most appropriate option from the list below. Select ONE option only.