September 17, 2017

DRESS: What does the emergency physician need to know?

Authors: Matthew Nemero, DO (Resident Physician, SAUSHEC) and Joshua Oliver, MD (EM Attending Physician, SAUSHEC) // Edited by: Alex Koyfman, MD (@EMHighAK) and Brit Long, MD (@long_brit)
Case
A 15-year-old male patient presents to your emergency department with his family complaining of a fever for 3 days and a rash that started on his face and chest that has been spreading for 3 days. Past medical history is significant for 3 ED visits in the past 90 days and a new diagnosis of epilepsy for which he recently started seeing a neurologist and was placed on phenytoin 3 weeks ago.
Vitals: HR 84, BP 122/74, RR 12, T 38.8 (101.8F), SpO2 99% RA
  • On physical exam, you palpate enlarged and tender cervical and axillary lymph nodes.
  • You note the generalized rash shown below. It does not involve the oral mucosa.

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