virgola82
Forum Guru
Topics: 85
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A 45 yo woman presents to your ofiice after developing a pruritc rash and a fever. She first noticed it on her wrists 2 weeks ago but states taht it has now pread to her feet as well. her past medical history is significant for a seizure disorder following the removal of a meningioma. She has been treated with dilantin. Physical exam is significant for icteric sclera. There are polygonal, flat topped violaceous papules limited to her wrists and her ankles. A white reticulated lacy lesion is also evident on her buccal mucosa. Her liver is enlarged and nontender to palpation. Lab tests reveals: PT 11 sec; albumin 3.6, alk phos 160U/L AST 700, ALT 960, ANA 1:160. anti HCV is negative, anti-HBsAg is + and anti HBcAg is -. ESR is 20mm/h and cholesterol is 160 mg/dl. Anti Smooth muscle antibody test is negative and ultrasound of the abdomen is normal.
What would you do next?
A Start prednisone
B Initiate interferon alfa 2 b thearpy
C give N-acetilcysteine
D Stop dilantin
E Start methotrexate
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| arlete
Forum Fanatic
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D
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Que sera sera whatever will be will be...
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| sprint123
Forum Guru
Topics: 129
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Dilantin----Can cause measles like rash and also hepatitis picture as in this patient---Remove the offending drug in a symptomatic drug-induced hepatitis patient!
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| dr in trouble
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D
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If u want to do something, do it today as there is no tomorrow.
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| usmlestud
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