The presence of certain clinical and laboratory findings should alert the clinician that a patient may be developing a serious or life-threatening cutaneous drug reaction.


Systemic findings:

(1) temperature > 40°C

(2) lymphadenopathy

(3) arthralgias or arthritis

(4) shortness of breath or wheezing

(5) hypotension


Dermatologic findings:

(1) confluent erythema

(2) facial edema or central facial involvement

(3) skin pain

(4) palpable purpura

(5) skin necrosis

(6) blisters or epidermal detachment

(7) positive Nikolsky's sign

(8) mucous membrane erosions

(9) urticaria

(10) swelling of the tongue


Laboratory findings:

(1) eosinophilia with count > 1,000 per µL

(2) lymphocytosis with atypical lymphocytes

(3) abnormal liver function tests


The presence of one or more of these findings should prompt an immediate evaluation of the patient and possible discontinuation of the implicated medication.


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