LAUSR

A 58-year-old man presented to the emergency department (ED) with pruritic rash, hives, joint pain and swelling, and diarrhea for 3 days. His medical history included hepatic steatosis, gastritis, depression, anxiety, and insomnia. Home medications were atorvastatin, esomeprazole, zolpidem, perphenazine, amitriptyline, and alprazolam. The rash was generalized, circumscribed, raised, and tender and had erythematous plaques with central pallor (Figs. 1, 2). He had been prescribed atorvastatin for 2 years but had not taken it in the previous 2 months. His symptoms occurred 12 hours after restarting atorvastatin. In the ED, he was febrile (39.4°C) with a white blood cell count of 12.6 k/dL, without eosinophilia. A trial of diphenhydramine provided no relief. In dermatology clinic, he received oral hydroxyzine and triamcinolone cream. His rash improved, and he restarted atorvastatin upon discharge. Two days later, he returned to the ED febrile (38.8°C), with hives, generalized erythematous patches, and bilateral hand swelling, which resolved with prednisone taper for 5 days and famotidine. He restarted atorvastatin, along with his other medications, after his ED discharge. Three days after restarting atorvastatin, he returned to the ED with generalized erythematous patches and facial swelling with difficulty breathing