Q. An 8-year-old Hispanic girl is brought to the emergency department for fever, skin rash, and facial swelling for the past 2 days. Her mother says the symptoms initially started with a fever and a rash on her face. She has given her fever-reducer syrup and made her sleep. But after she woke up in the morning, her face is swollen with a bigger-sized rash and also it has spread over her trunk and hands. She also vomited twice in the morning. The rash is not painful or itchy. Her medical history shows that she has been diagnosed with pulmonary tuberculosis and is on treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol for the past 7 weeks. Her temperature is 101.5°F (38.6°C), pulse is 110/min, blood pressure is 80/60 mmHg, and respirations are 16/min. Physical examination shows icteric eyes and facial edema with swollen lips and ear lobes. A generalized maculopapular exanthema is noted on the face, trunk, and upper extremities. Abdominal examination shows mild hepatosplenomegaly and enlarged bilateral inguinal lymph nodes. Mucosal membranes are intact.
Laboratory investigations are shown below.
What is the most likely diagnosis for this patient based on her clinical features?