MRCP2-0774

MRCP2-0774

A 60-year-old man presents to the Emergency Department with a rash that has developed over the past 24 hours. He has been feeling increasingly unwell throughout the day. The patient has a medical history of hypertension and gout, and was recently started on allopurinol due to an increase in gout attacks. He also takes ramipril and amlodipine.

Upon examination, the patient has an erythematous maculopapular rash covering his entire body, with the worst of it on his trunk. He is tachycardic at 105 beats per minute, with a blood pressure of 110/55 mmHg and a temperature of 38.1 ºC. He reports residual pain in his right great toe, but no other focal signs or symptoms.

The patient’s blood tests reveal the following:

Hb 130 g/l Na+ 141 mmol/l
Platelets 550 * 109/l K+ 4.7 mmol/l
WBC 12.5 * 109/l Urea 6 mmol/l
Neuts 6 * 109/l Creatinine 95 µmol/l
Lymphs 5 * 109/l CRP 65 mg/l
Eosin 1.5 * 109/l

What is the most likely diagnosis?