Question

The patient came with history of bullae involving >30 "A, body surface area along with erosions of the lips and other mucosae for the past 7 days. What is the most probable underlying etiology ?

• A. Bacterial infection
• B. Viral infection
• C. Drugs
• D. Malignancy

Answer 1

The Correct Option is C

To determine the most probable underlying etiology for the patient's condition, we analyze the clinical presentation: the presence of bullae involving >30% body surface area along with erosions of the lips and other mucosae over a 7-day period. This presentation is indicative of a severe cutaneous adverse reaction.

The key points to consider are:

• The widespread distribution of bullae and the involvement of multiple mucosal surfaces.
• The acute onset and significant body surface area involved, which suggests a systemic cause.

With these observations, let's evaluate the given options:

1. Bacterial infection: Bacterial skin infections such as impetigo usually do not present with such extensive body surface involvement and mucosal erosion.
2. Viral infection: While viral infections like herpes simplex can cause mucosal lesions, they do not typically cause widespread bullae covering >30% of the body surface area.
3. Drugs: Drug reactions, particularly Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), are well-known causes of widespread bullae and mucosal erosions affecting large areas of the skin and mucous membranes. The acute, extensive nature of the symptoms aligns with a severe drug-induced reaction.
4. Malignancy: Although malignancies can cause paraneoplastic skin conditions, they do not typically manifest solely as acute widespread bullae and mucosal erosions.

Given the information, the most probable underlying etiology for the patient's condition is drugs, consistent with a severe drug reaction such as Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis.