Case Description
A 23-year-old female patient who was commenced on sulfasalazine and hydroxychloroquine five weeks ago for a newly diagnosed seronegative rheumatoid arthritis presented for evaluation of a 10-day history of progressive skin rash, which initially started on her trunk and spread peripherally to her extremities, neck, and face. She stopped her medications since the onset of the rash; however, her facial swelling and redness had increased over the past few days before the presentation. She also reported subjective fever, chills, dry cough, and joint pains in the lower extremities.
On examination, she was feverish with a temperature of 103 °F, tachycardic with a heart rate of 110 beats per minute, a blood pressure of 100/60 mmHg, tachypneic with a respiratory rate of 25 per minute, and an oxygen saturation of 90% at room air. Cervical lymphadenopathy and hepatosplenomegaly were noted. Skin examination revealed widespread erythematous morbilliform eruptions distributed on the trunk and extremities, including palms and soles, covering approximately 80 % of the total body surface area (TBSA) with follicular accentuation on the lower extremities. Confluent erythema of the face with facial edema with multiple discrete perifollicular pustules were observed along the frontal hairline and throughout the scalp. No oral or vaginal mucosal involvement or desquamation was observed. (Figure 1 Panel A-C). The lung examination was unremarkable, but a stridor was noted, for which she was intubated for airway protection.