Question

HIV pt with a 3 day Hx of fever presents with targetoid skin lesions, lip/mouth ulceraction, and visual imairment. PEx notable for skin sloughing (8% BSA). nikolsky sign (+). he was placed on allopurinol 10 days ago for chronic gout. what if > 30% BSA?

Answer 1

The patient's symptoms suggest a severe drug reaction consistent with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis, which are emergencies especially severe in HIV patients and require immediate medical attention.

Step-by-step explanation:

The description provided is indicative of a patient experiencing symptoms relating to a severe drug reaction, most likely Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), especially since the patient began allopurinol treatment 10 days ago. These reactions can occur in HIV patients and are characterized by skin lesions, mucous membrane erosions, and systemic symptoms. SJS/TEN is a medical emergency and the extent of body surface area (BSA) involvement is crucial; if skin sloughing affects more than 30% BSA, it is classified as TEN, which has a higher morbidity and mortality rate compared to SJS, where skin sloughing involves less than 10% BSA. Immediate discontinuation of the offending agent and prompt referral to a burn unit or intensive care unit for supportive care and management is necessary.