No abstract

A 20-year-old man presented to the emergency department in May 2013 with a new rash that had gradually progressed over 1 day. He also noted several days of sore throat, fever, malaise, and cervical lymphadenopathy preceding the rash. He lived in Maryland, his medical history was unremarkable, and he denied any new medications. On physical exam, he had enlarged tonsils and cervical lymphadenopathy. He had no hepatosplenomegaly. In addition, his skin showed erythematous papules too numerous to count, as well as plaques of varying size and morphology on his face, trunk, palms, and extremities, yet there were no lesions on his mucus membranes or genitals (Figures 1-3). The lesions were nonblanching and mildly pruritic. Initial laboratory evaluation in the emergency department

A 22-year-old human immunodeficiency virus-infected male presented with fever, rash, hypotension, and renal insufficiency 18 days following initiation of therapy with an efavirenz-based antiretroviral regimen. Although rash is a common side effect of efavirenz, severe hypersensitivity reactions are rare. Systemic symptoms can include hepatic toxicity and pneumonitis, and in one instance death. Corticosteroids are the mainstay of treatment.