Author: Akbar Shareef Babar / Editor: Emily Rashleigh / Codes: AC1, AP1, DC10, DC9, SLO5 / Published: 07/01/2026
A 10-year-old boy presents to the Emergency Department (ED) with his mother, reporting a 2-day history of fever, malaise, and rapidly spreading skin lesions. His mother states that the lesions initially appeared as small red spots on his trunk and face but quickly progressed into painful blisters and erosions.
He also reports severe oral discomfort, making it difficult to eat or drink, along with painful swallowing and redness with irritation of both eyes. He describes mild sensitivity to light but denies any visual changes.
He was commenced on oral amoxicillin seven days earlier for a mild cough and sore throat prescribed by his GP. There is no recent viral illness, vaccination, travel, or known exposure to infectious diseases. He is otherwise well, with nil past medical history of note. He has no known drug allergies, and family history is non-contributory.
Observations on arrival:
- Temperature: 38.8°C
- Heart rate: 115 bpm
- Blood pressure: 95/60 mmHg
- Respiratory rate: 22/min
- Oxygen saturation: 98% on room air
On examination, the child appears uncomfortable but remains alert and interactive. Skin examination reveals dusky erythematous macules with early blistering involving approximately less than10% of the body surface area, with a positive Nikolsky sign.
The oral mucosa shows widespread erosions and hemorrhagic crusting of the lips.
The eyes demonstrate bilateral conjunctival injection with mild discharge.There is no lymphadenopathy or hepatosplenomegaly.
Initial laboratory investigations show: WCC 13 ×10⁹/L, CRP 75 mg/L; renal and liver function tests are normal.
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