One cannot overstate the value of a detailed skin examination in the diagnosis of systemic disorders, including infectious diseases. This precept was demonstrated in the present case.A 41-year-old man with stage-IV T-cell-rich B-cell lymphoma presented to our emergency department reporting a 2-day history of fever, diarrhea, and malaise and a 3-week history of multiple tender, erythematous skin lesions located on his arms, trunk, and lower extremities. The lesions had been initially treated with oral clindamycin for a presumed diagnosis of cellulitis, without significant improvement. His medications on presentation included enoxaparin, erythropoietin, and filgrastim.
He had completed his 6th cycle of chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab 12 days earlier. He had been admitted to the hospital 6 weeks prior for an episode of febrile neutropenia. At that time, blood, urine, and sputum cultures had been negative. He had been treated empirically with standard doses of intravenous piperacillin-tazobactam and metronidazole until defervescence and neutrophil recovery.
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— Yasbanoo Moayedi, MD, Paul E. Bunce, MD, Shachar Sade, MD, Danny Ghazarian, MD, Wayne L. Gold, MD
This article originally appeared in May 2012 issue of The American Journal of Medicine.
