188.A 22-year-old man presents to the ED with a 3-day history of rash,
fever, malaise, and mouth sores. He has been unable to eat because of
mouth pain. He denies arthralgias, penile discharge, new medications,
drug allergies, or prior similar episodes. On examination, the patient’s BP is
100/60 mm Hg, HR is 110 beats per minute, RR is 20 breaths per minute,
and temperature is 102°F. The patient appears alert but uncomfortable. He
has multiple vesiculobullous lesions on his conjunctivae and mouth as
seen in the image below. Visual acuity is 20/20. Target lesions are found on
his palms and soles. What is the most appropriate next step in management?
188 Emergency Medicine
a. Discharge him with analgesics, antihistamines, and mouth rinses.
b. Discharge him with acyclovir, analgesics, antihistamines, and mouth rinses.
c. Discharge him after 1-L normal saline IV; and prescriptions for analgesics, anti-
histamines, oral prednisone, and mouth rinses.
d. Admit him and administer 1- to 2-L normal saline IV, oral prednisone, anal-
gesics, antihistamines, and mouth rinses.
e. Admit him and administer 1- to 2-L normal saline IV; analgesics, and acyclovir IV.
(Reproduced, with permission, from Shah BR, Lucchesi M.Atlas of Pediatric Emergency
Medicine.New York, NY: McGraw-Hill; 2006: Figure 7-5.)