Abstract
p e l d d g t a I PRESENTATION Sometimes, appropriate treatment can introduce new problems for patients who are already seriously ill. This was true for a 62-year-old man with a history of chronic obstructive pulmonary disease, atrial fibrillation, and peripheral vascular disease. He was admitted to the hospital for a gangrenous right foot, and his medications on admission included aspirin, gabapentin, paroxetine, ranitidine, and tramadol. On the first day of admission, he was febrile to 101.5° F (38.6° C) and was started on piperacillin-tazobactam and vancomycin. These antibiotics were administered for 2 weeks and then discontinued the day before a below-theknee amputation. One day after the amputation, he was restarted on piperacillin-tazobactam and vancomycin. Within 24 hours of re-institution of the antibiotics, the patient became febrile to 101.7° F (38.7° C) and developed erythema of his face, which quickly progressed to his trunk and extremities. Subsequently, a thin yellowish scale arose on his entire face. He denied any pain, pruritus, facial swelling, or mucosal changes.
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