Bullous Drug Eruption Treated With Amputation

Abstract

<h3>REPORT OF A CASE</h3> The inpatient consultation service was asked to evaluate a 55-year-old woman with a bullous eruption of acute onset. The patient had been admitted to the hospital for cellulitis surrounding a chronic left lower extremity ulcer. Her history included diabetes mellitus type I for 45 years, hypertension, and severe peripheral vascular disease. She had undergone balloon angioplasty in the past but required a left femoral-peroneal bypass procedure several months prior to admission because of vessel reocclusion. On admission, the patient's physical examination revealed a ragged, necrotic ulcer overlying the left first metacarpophalangeal joint with purulent exudate and surrounding dusky erythema. Pulses were absent in both ankles. Bacterial culture of the ulcer and bone biopsy culture of the underlying unexposed bone both yielded methicillin sodium—resistant<i>Staphylococcus aureus</i>and<i>Streptococcus viridans</i>. A magnetic resonance imaging scan of the foot demonstrated osteomyelitis of the bone underlying the ulcer. The patient