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4th March 2024
A 16-year-old has presented to the emergency department with an itchy rash.
A 16-year-old has presented to the emergency department with an itchy rash. She has had this rash for the last 3 days. She has noticed that she has had a wheeze. She denies any cough, fevers or chest pain. Her mum has noticed that her face is more swollen than normal. She tells you she has not passed any urine in the last 2 days.
On examination, she has a blanching maculopapular rash across her torso and chest with visible excoriations. She has a heart rate of 72 bpm, respiratory rate of 12 bpm, blood pressure of 171/92 mmHg, a temperature of 37.2 °C and oxygen saturation of 97%. She is markedly oedematous with pitting oedema up to the knees and has oedema of the hands and face.
Her blood results are below:
| Blood Results | Reference Ranges | |
| Na | 135 | 135-145 mmol/L |
| K | 6.4 | 3.5-5 mmol/L |
| Creatinine | 378 | 70-150 μmol/L |
| Urea | 18 | 2.5-6.7 mmol/L |
| eGFR | 4 | >90 mL/min/1.73m2 |
| CRP | 3 | <5 mg/L |
| WCC | 8.4 | 4-11 x1012/L |
| Eosinophils | 3.1 | 0.04–0.44 x109 /L |
A urine-dip has shown:
| Leukocytes | +++ |
| Nitrates | Negative |
| Blood | Negative |
| Protein | ++ |
Which medication is most likely to explain the patient’s presentation?
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