Rash and Fever

Today we discussed an approach to a patient presenting with fever and rash who ultimately seemed to have a drug reaction to his antiretroviral medications. We focused our discussion around a differential diagnosis of a rash in this context while touching briefly on immune reonstitution inflammatory syndrome.

Drug hypersensitivity syndromes manifest as part of a triad: fever, rash and end organ involvement (hepatitis, thyroiditis, lymphadenopthy, renal failure). Stopping the offending drug and providing supportive care is the cornerstone of treatment.

With regards to timing of therapy in patients with TB and HIV, here is a NEJM article .