Case #3
Do No Harm

Case Goals
  • Obtain a thorough history
  • Perform a focused physical exam
  • Provide a differential and the most likely diagnosis
  • Order the most specific procedure or test that will nail down the diagnosis

    • Goals

  • Obtain a thorough history
  • Perform a focused physical exam
  • Provide a differential and the most likely diagnosis
  • Order the most specific procedure or test that will nail down the diagnosis
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    Assistant Avatar

    Greetings, my aspiring colleagues. I am Dr. Alfred Schmurtz III, and it's my pleasure to serve as your guide through the fascinating journey of medical discovery. The case before us is titled "Do No Harm" based on a true story from "Med Mal Reviewer" (https://substack.com/@expertwitness). Our patient is Sarah Bellino, a 38-year-old female with history of recurrent UTI who presents for follow up to your very own clinic. She was seen previously by one of your partners, Dr. Smith. He's known for his "quick and dirty" approach to medicine, incapable of using the EMR, and has the handwriting of a blind bat so you're not sure why she is coming in for follow up. As you step into the shoes of her PCP, it is your task to unravel the mystery of her ailment. To begin, I will adopt the persona of the patient, providing you with her perspective and symptoms as accurately as possible. Why don't you ask me how I'm doing?

    Case Complete!

    High Yield points about this case:

    • Stevens-Johnson Syndrome (SJS) is a rare, serious disorder affecting less than 2 people per million annually.
    • Medications are the most common trigger for SJS, especially antibiotics, anticonvulsants, and NSAIDs.
    • Recovery from SJS typically takes 2-6 weeks, and skin regrowth begins within 3 days of stopping the causative drug.
    • 42% of SJS patients experienced conjunctivitis before the onset of skin eruption. These patients also had better vision outcomes when started on ocular steroids. Source: https://expertwitness.substack.com/p/stevens-johnson-syndrome-presentingUp to 90% of SJS cases involve mucous membrane complications, often affecting the eyes, mouth, and genitals.