Stevens-Johnson syndrome presents with fever and flu-like symptoms 1-3 days before which findings?

• A. Fever and malaise/URI symptoms for 1-3 days prior to painful oral and skin erythematous macules with purpuric centers.
• B. Itchy rash only.
• C. Rash that appears without prodrome.
• D. Painless patches.

Answer: (A)

Stevens-Johnson syndrome typically begins with systemic illness—fever and flu-like symptoms—that appear 1–3 days before the skin and mucous membrane findings. This prodrome is followed by the development of painful mucosal lesions, especially in the mouth, along with erythematous skin macules that often have purpuric centers. The combination of a brief feverish/flu-like period preceding painful oral and skin lesions with purpuric centers is the hallmark pattern. Other choices describe features that don’t fit this sequence: itching alone, rash without any prodrome, or painless patches are not characteristic of SJS, which centers on painful mucosal involvement and rapidly evolving erythematous/necrotic skin lesions.