18/11/2025
A 59-year-old woman presents to the emergency department with fever, profound weakness, and a rapidly spreading rash for 24 hours. Two days earlier, she started tetracycline for acne rosacea.
On examination:
• Multiple sharply demarcated, round to oval violaceous-red patches on the trunk and limbs
• Several lesions show central dusky discoloration
• Some have begun to form bullae
• No mucosal involvement
• She reports that she had a “similar spot” on her thigh years ago after taking an unknown antibiotic.
Vital signs:
• Temp 38.8°C
• Pulse 102/min
• BP normal
Question: What is the most likely diagnosis?
A. Stevens–Johnson syndrome (SJS)
B. Generalized fixed drug eruption
C. Drug reaction with eosinophilia and systemic symptoms (DRESS)
D. Erythema multiforme major
