History A normally healthy man aged 28 years developed an acute sore throat. He consulted his general practitioner (GP) and a diagnosis of acute pharyngitis was made, presumed streptococcal, and oral penicillin was prescribed. The sore throat gradually improved, but5 days later the patient noted a rash on his arms, legs and face and painful ulceration of his lips and mouth. These symptoms rapidly worsened; he felt very unwell and presented to the emergency department. There was no relevant previous medical history or family history.
He had sore throats occasionally in the past, but they have resolved with throat lozenges. Examination He looked ill and had a temperature of 39.2°C. There were erythematous tender nodules on his arms, legs and face and ulcers with some necrosis of the lips and buccal and pharyngeal mucosae. The rest of the examination was normal. Haemoglobin…
