SHM Converge Scientific Abstract ePoster Gallery-Maculopapular Rash Three Out of Ten

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This case describes a 53-year-old woman with systemic lupus erythematosus (SLE) who developed a severe, rapidly progressive maculopapular rash after recent treatment with ceftriaxone and phenytoin following bacterial meningitis and a brain abscess. She presented with fever, confusion, diffuse dusky targetoid lesions affecting about 40% of her body surface area, and prominent oral and genital mucosal ulceration.  <br /><br />Because the presentation could represent erythema multiforme, toxic epidermal necrolysis (TEN), or a severe lupus flare with TEN-like acute cutaneous lupus erythematosus (ACLE), the team broadened treatment by stopping the suspected drugs, starting broad-spectrum antibiotics, and giving intravenous steroids. Laboratory studies showed active lupus serologies, including elevated ANA, anti-DNA, anti-Smith, and anti-RNP antibodies with low complement levels.  <br /><br />A skin biopsy confirmed TEN by showing full-thickness epidermal necrosis, and did not show histologic features of cutaneous lupus, making TEN the more likely diagnosis despite evidence of active SLE. Cyclosporine was started, but her rash progressed to 60% body surface area with bullae and skin sloughing, requiring transfer to a burn center, where she ultimately recovered.  <br /><br />The report highlights the diagnostic challenge of distinguishing TEN from TEN-like cutaneous lupus in patients with SLE. Helpful clues favoring TEN include a recent culprit medication, rapid progression, diffuse symmetric rash, and extensive mucosal involvement. TEN-like lupus more often follows a lupus flare, evolves more gradually, and tends to show photosensitive distribution, milder mucosal disease, and lupus-specific histopathology. Accurate distinction is critical because management and prognosis differ substantially in this life-threatening condition.

Asset Subtitle

Sagar A. Patel

Meta Tag

Author List Abu Baker Sheikh, Rhoda Jiao, Sagar A. Patel

Category Clinical Vignettes

Concept Toxic Epidermal Necrolysis

Concept TEN-like Cutaneous Lupus Erythematosus

Concept Cutaneous Lupus

Concept Systemic Lupus Erythematosus

Concept Mucosal Involvement

Distinguished Non-Finalist

Presenter Organization University of New Mexico School of Medicine

Presenting Author Sagar A. Patel

Track Adult

Keywords

systemic lupus erythematosus

toxic epidermal necrolysis

TEN-like acute cutaneous lupus erythematosus

maculopapular rash

mucosal ulceration

ceftriaxone

phenytoin

skin biopsy

full-thickness epidermal necrosis

burn center

Toxic Epidermal Necrolysis

TEN-like Cutaneous Lupus Erythematosus

Cutaneous Lupus

Systemic Lupus Erythematosus

Mucosal Involvement