Explain a severe drug eruption to a parent — OSCE

Candidate instructions

You are the paediatric registrar. You have five minutes to speak with Mrs Patel, whose seven-year-old son Arjun was started on phenytoin for new-onset epilepsy six weeks ago and has just been admitted with a fever, a widespread red rash, a swollen face, enlarged glands, and blood tests showing eosinophilia and hepatitis. You have made the diagnosis of DRESS, a severe drug reaction to the phenytoin. Mrs Patel is frightened and confused — the medicine was meant to help Arjun, not make him ill. Explain what DRESS is in plain language, why the phenytoin caused it, what the treatment and the outlook are, and the plan for his epilepsy going forward — honestly and without overpromising. Answer her questions, check her understanding, and agree a plan with her. ^[3]