A previously healthy 13-year-old boy developed a sore throat and swollen right eye two days prior to admission. His primary care physician prescribed a course of amoxicillin for pharyngitis. He subsequently developed a high fever and diarrhoea and was taken to the emergency room, where the second dose of amoxicillin was administered. He defervesced and was discharged home. On the day of the admission, he was unable to tolerate oral intake, suffered two episodes of haematemesis, and developed conjunctival inflammation, blistering of his lips, and an erythematous rash on his cheeks.
Examination
He was found to be tachycardic, hypertensive, and febrile at an outside emergency room and was transferred to our institution for further management. His physical exam was notable for erythematous papules present on his trunk and extremities involving <5% of body surface area (BSA), with diffuse erosions and sloughing of the lips, tongue, buccal and palatal mucosa. Periorbital swelling was present predominantly on the right with marked bilateral conjunctival inflammation. His abdomen was soft and non-distended with normal peristalsis. Small vesicles were noted on the scrotum without obvious involvement of urethral meatus or glans.
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