A 51-year-old woman is evaluated for generalized rash, facial edema, fever, and severe fatigue that have developed over the past week. She was recently diagnosed with rheumatoid arthritis. She currently takes prednisone, hydroxychloroquine, and sulfasalazine. She has no previously known allergies.
On physical examination, temperature is 39.1 °C (102.3 °F), blood pressure is 110/78 mm Hg, pulse rate is 108/min, and respiration rate is 25/min. The face is edematous. Skin examination reveals a generalized morbilliform eruption. The skin is not painful, and no blisters are present. There is no ocular or mucosal involvement. Lymphadenopathy is noted in the cervical and axillary regions. Laboratory studies show a serum alanine aminotransferase level of 330 U/L and a serum aspartate aminotransferase level of 355 U/L. Results of a complete blood count are normal except for 16% eosinophils.
A) Drug reaction with eosinophilia and systemic symptoms (DRESS)
B) Erythema multiforme
C) Stevens-Johnson syndrome
D) Toxic epidermal necrolysis