An 83‐year‐old woman underwent a pacemaker insertion for bradycardia. Her medical history included hypertension treated with nifedipine, and she had no drug allergies. At the time of the cardiac procedure she received a prophylactic single dose of intravenous flucloxacillin 1 g. Two days later she was noted to have a fever of 38 °C. A full sepsis screen was negative. Blood tests revealed elevated C‐reactive protein (CRP) level [177 mg/L; normal < 10 mg/L] and normal white cell count (WCC) (8.46 × 109/L; normal range (NR) 4–11 × 109/L] and neutrophil count (6.44 × 109/L; NR 2–7.5 × 109/L). She was empirically started on piperacillin with tazobactam. Twenty‐four hours later, she developed an extensive rash and oliguria (urine output 10–20 mL/kg/h; normal is at least 0.5 mL/kg/h), which was not responsive to intravenous fluids. Her creatinine level peaked at 282 μmol/L (stage 3 acute kidney injury; AKI) from a baseline of 90 μmol/L (NR 50–110 μmol/L). Her CRP further increased to 334 mg/L and WCC was elevated (13 × 109/L), with neutrophilia (12 × 109/L) and eosinophilia (0.6 × 109/L; normal range 0.04–0.4 × 109/L). A repeat septic screen, including urine analysis, chest radiography and blood cultures, was negative.On physical examination, the patient was found to be erythrodermic with confluent oedematous erythema. There were widespread monomorphic nonfollicular pustules on the chest, abdomen, major flexures, arms
Clinical & Experimental Dermatology – Wiley
Published: Jan 1, 2018
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