A 45-year-old man (weight 70 kg) is admitted to the intensive care unit with toxic epidermal necrolysis (TEN) involving >30% of his body surface area and mucous membrane involvement. His SCORTEN score is 4. The offending antibiotic was discontinued 24 hours ago. In addition to intensive supportive care, which of the following is the most appropriate initial pharmacologic therapy?

A 45-year-old woman presents with widespread erythematous macules, targetoid lesions, and bullae with a positive Nikolsky’s sign involving over 30% of her body surface area, consistent with toxic epidermal necrolysis. She reports her rash began 5 days ago after starting a new antibiotic for a urinary tract infection. She delayed seeking care due to limited health literacy and lack of a primary care provider. Which of the following interventions best addresses the health system barriers that contributed to her delayed presentation and severe disease?

A 48-year-old female is admitted to the intensive care unit on assist-control ventilation and a norepinephrine infusion for distributive shock. She was started on amoxicillin/clavulanate five days ago for community-acquired pneumonia. Over the past 48 hours, she has developed a rapidly progressing erythematous, blistering rash covering >30% of her body surface area, with mucosal involvement of the eyes and mouth. Skin biopsy shows full-thickness epidermal necrosis with sparse lymphocytic infiltrate at the dermal–epidermal junction. Her SCORTEN score is 4. There is no evidence of active bacterial infection beyond her initial pneumonia. Which of the following is the most appropriate initial pharmacologic therapy for this patient’s condition?

A 45-year-old man is admitted to the ICU with rapidly progressing toxic epidermal necrolysis (TEN) involving 35% of his body surface area, blistering of the trunk and face, and mucosal involvement of the eyes and mouth. He is intubated, on vasopressor support, and the offending antibiotic has been discontinued. In addition to intensive supportive care (fluid management, wound care, infection prevention, and nutritional support), which of the following systemic immunomodulatory therapies has the strongest evidence for initial adjunctive use in SJS/TEN?

A 45-year-old man (weight 70 kg) presents with progressing Stevens-Johnson Syndrome involving 15% of his total body surface area despite 48 hours of intravenous methylprednisolone 1 mg/kg/day (70 mg/day). New bullae and epidermal detachment continue to develop. He has uncontrolled hyperglycemia (250–350 mg/dL) and fever (38.8 °C) with leukocytosis (WBC 18,000/mm³), suggesting steroid-related complications and possible infection. Which of the following is the most appropriate next pharmacologic therapy?

A 45-year-old man with Stevens-Johnson Syndrome (SJS) progressing to SJS/TEN overlap (25% TBSA involvement, SCORTEN score 3 [≈35% mortality]) remains on methylprednisolone 1 mg/kg/day. He develops persistent hyperglycemia (>300 mg/dL) and a new fever of 39.5 °C with rising procalcitonin; blood and wound cultures are pending. His skin lesions continue to spread despite 24 hours of corticosteroid therapy. Which of the following is the MOST appropriate pharmacotherapeutic adjustment?

A 45-year-old male (weight 70 kg) is admitted to the ICU with Stevens–Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) involving 25% of his body surface area and significant mucosal involvement. He is intubated, on norepinephrine for hypotension, and receiving CRRT for acute kidney injury. He developed the rash 48 hours after starting sulfamethoxazole/trimethoprim. Which of the following is the MOST important initial management step?

A 45-year-old man (weight 70 kg) is admitted to the ICU with Stevens–Johnson Syndrome involving approximately 20% of his body surface area and a SCORTEN score of 3. He required endotracheal intubation for airway protection because of extensive oral mucosal sloughing. He is on a low‐dose norepinephrine infusion via a central line for mild hypotension. Laboratory results show serum creatinine 1.1 mg/dL and normal liver function tests. The suspected offending agent (allopurinol) was discontinued on admission. Which of the following is the most appropriate initial management strategy?

A 48-year-old female is admitted to the critical care unit with extensive Stevens-Johnson Syndrome (SJS), affecting approximately 25% of her total body surface area. She is intubated and on assist-control ventilation, receiving a continuous norepinephrine infusion through a central line to maintain mean arterial pressure. Initial pharmacologic management includes intravenous methylprednisolone 1.5 mg/kg/day. The patient’s current blood glucose is 285 mg/dL, and her skin lesions show continued blistering and epidermal detachment. Which of the following monitoring parameters should be prioritized to assess both treatment efficacy and potential drug-related toxicities?

A 45-year-old female with severe Stevens–Johnson syndrome (25% TBSA detachment and extensive mucosal involvement) is admitted to the ICU. After initial resuscitation, you are asked to recommend the most evidence-supported immunomodulatory therapy to halt disease progression. Which of the following is the preferred initial pharmacologic intervention based on current data?