Presenter: Jonathan Richey, DO, Monica Nafsou, DO

Dermatology Program: Pontiac/Botsford Osteopathic Hospital

Program Director: Annette LaCasse, DO

Submitted on: July 2, 2010

CHIEF COMPLAINT:  “Red, painful rash on butt and armpits.”

CLINICAL HISTORY: A 44-year-old Caucasian male with a history of lower extremity osteomyelitis was treated with Unasyn and Vancomycin following below the knee amputation. The patient had no prior medical history, largely due to inadequate health maintenance. He had a 20-pack year history of smoking. On the eighth day of treatment with antibiotics after amputation, the patient developed a “rash.” The patient described the lesions as “very painful” – the worst areas being the right axilla and sacral area.

PHYSICAL EXAM:
Erythematous, erosive plaques and flaccid bullae on his buttocks. The right axillae, deltoid, chest, and back had a morbilliform eruption and multiple 6-8 mm erythematous well-circumscribed plaques.

LABORATORY TESTS:

Stable vitals, stable normocytic anemia, mild hyponatremia

DERMATOHISTOPATHOLOGY: N/A

DIFFERENTIAL DIAGNOSIS:

1.   Systemic Drug-Related Intertriginous and Flexural Exanthem (Baboon Syndrome)
2.   Acute Generalized Exanthematous Pustulosis (AGEP)
3.   Fixed Drug Eruption
4.   Drug Rash/Eosinophilia/Systemic Symptoms (DRESS)