A 58-year-old woman was admitted to the acute medical unit with an eight-day history of feeling unwell and a painful spreading rash. It had commenced on her trunk and extended to the limbs. She had missed the last two days of work as a machinist. She had a previous history of slight scalp psoriasis. Two weeks ago, she had commenced medication for joint pains. She had a past medical history of a myocardial infarction and hypertension. Her medication included atenolol, bendroflumethiazide, aspirin, and diclofenac.
On examination, she had a temperature of 39.2°C, pulse 120 beats per minute, and a blood pressure of 130/92 mmHg. Respiratory, abdominal, and neurological systems were normal. Skin examination revealed sheeted erythema of her back and loins, with areas of superficial skin shedding revealing moist underlying eroded areas on most of her back, the axillae, and beneath the breasts amounting to 20% body surface area. There was patchy redness with purpuric macules on the limbs, palms, and soles. She had painful eyes and small foci of oral mucosal erosion. The genital mucosa was uninvolved, but there was redness of the inguinal and perineal creases with a well-demarcated edge and satellite patches beyond. She had scaling of the scalp.
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