Morning report 2.5.2020

Today’s morning report was about elderly patient with MM s/p SCT on chemotherapy admitted with very high fever, tachycardia and morbiliform rash on trunk as well as lesion on L arm. The lesion quickly evolved into bulla, patient was appropriately treated with broad-spectrum antibiotics. Cultures the next day (from blood and from lesion) grew Pseudomonas leading to diagnosis of ecthyma gangrenosum.

Similar case from NEJM with some more information here nejmicm1702302

Also check out Amanda’s slides morning report (Heuszel, Amanda)

Most importantly from this case is DDx for fever + rash in this patient:

  • Stevens-Johnson syndrome (SJS)
  • Toxic Epidermal Necrolysis (TEN)
  • Morbilliform drug eruption
  • DRESS (Drug rash with eosinophilia and systemic symptoms)
  • Disseminated fungal/bacterial infections. Most common: Staph, Strep, Pseudomonas, Aspergillus, Candida
  • Chronic graft-vs-host disease

 

AS

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