19th March 2024

You are called to the neurology ward to review a patient with persistent fever and a new rash

You are called to the neurology ward to review a patient with persistent fever and a new rash. On review, the patient is 24 years old with severe epilepsy and learning difficulties. He has had a prolonged admission initially for seizure control, followed by treatment for thrombocytopaenia and investigation for aplastic anaemia. The patient has received several types of blood products, including a platelet transfusion 24 hours previously. The team are concerned that the pyrexia and rash are secondary to these blood products and have contacted the haematology laboratory for further investigation and have given antihistamines, which have not helped.

On examination, the patient is tachycardic and pyrexial. There is a diffuse maculopapular rash with mucosal involvement of the mouth and lips with scleral jaundice. There is significant cervical and axillary lymphadenopathy.  Kernig’s and Brudzkinski’s signs are negative.

A course of clindamycin was started two weeks ago to treat impetigo and her neurologist switched her anticonvulsant to carbamazepine six weeks ago.

Blood results from this morning is as follows:

What is the most likely cause of this patient’s symptoms?

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