Visual Diagnosis: Recurrent Seizures and Concomitant Skin Changes in a 16-year-old Boy

A 16-year-old Hispanic boy with a history of intermittent asthma presents to the emergency department (ED) with recurrent unprovoked seizures. The first episode was 2 weeks before this visit and was characterized by generalized tonic-clonic seizures (GCTSs), with a postictal phase of 10 minutes. He was seen in the ED during that episode, with normal findings on examination and evaluation, including a complete blood cell count, chemistry, liver function tests, urine toxicology, and a computed tomographic (CT) scan. During the current visit, he presents with a history of 2 episodes of unprovoked GTCSs 4 hours apart. The first episode lasted 5 minutes, followed by a postictal phase of 5 minutes. In the ED, he has normal physical examination findings and is discharged on oral oxcarbazepine with a diagnosis of idiopathic epilepsy. Before starting the prescribed medication, he develops another episode of GCTSs, approximately 7 to 8 minutes, with no postictal...