Would You Pick This Diagnosis?

A case history recently published in the BMJ highlights one of those uncommon but very diagnoseable conditions if you just spot the clues.

According to the French authors, the 62 year old man presented with a history of recurrent oral ulcers sometimes accompanied by laryngitis and conjunctivitis.

During one of these episodes he had developed an acute fever, a sore throat when swallowing and laryngitis – he had sought medical attention and was prescribed ibuprofen and clarithromycin. Two days after this, the man developed conjunctivitis, erosions in the mucosal membrane in the mouth and skin lesions.

Not unsurprisingly, the man’s attending doctors though he had Stevens-Johnson syndrome and sent him to hospital. Full examination showed painful diffuse erosions of mucous membranes not only of the oral cavity but also of the nose, the epiglottis and the glans. The skin lesions were noted to be target lesions involving three raised concentric red rings and they were found ...


Ingen-Housz-Oro S, Ortonne N, Chosidow O. The diagnosis is in the rings. BMJ. 2017 Oct 5; 359: j3817. DOI: 10.1136/bmj.j3817

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