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JAMA Ophthalmology Clinical Challenge
January 2018

Acute Bilateral Eyelid Edema in a 3-Year-Old Girl With Pyuria

Author Affiliations
  • 1Department of Ophthalmology, California Pacific Medical Center, San Francisco
  • 2Department of Ophthalmology, University of California, San Francisco
JAMA Ophthalmol. 2018;136(1):90-91. doi:10.1001/jamaophthalmol.2017.2978

A 3-year-old Asian girl presented to the emergency department with high fever (>40°C) of 2 days’ duration, bilateral upper and lower eyelid edema, and dysuria. Results of urinalysis revealed pyuria, and she was prescribed oral cephalexin, 250 mg every 12 hours, for a presumed urinary tract infection. The patient returned 2 days later with persistent fever, worsening eyelid edema, and a new macular rash over her buttocks and shins. At this time, the ophthalmology service was consulted owing to concern for Stevens-Johnson syndrome precipitated by the treatment with cephalexin.

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