رجل عمره ٣٣ سنة من أصل آسيوي، بدأ كاربامازيبين قبل أسبوعين للصرع. جاء بحرارة ٣٨٫٨ وطفح جلدي مؤلم ينتشر بسرعة مع فقاعات، وتقرحات في الفم والعينين. ما التصرف؟

A 33-year-old man of Asian descent started carbamazepine two weeks ago for epilepsy. He presents with fever 38.8 °C and a rapidly spreading painful rash with blisters, plus mouth and eye ulcers. What is the action?

1. Apply steroid cream and complete the course
2. Give an antihistamine and continue the drug
3. Stop the drug and notify the physician now (possible SJS)
4. Double the dose because the rash means the level is too low

Answer: C) Stop the drug and notify the physician now (possible SJS). Rash with mucosal ulceration and fever may be Stevens-Johnson syndrome, which is serious; the drug stops immediately. Some Asian ancestries with HLA-B*1502 are at higher risk.