A 71-year-old male patient with a history of coronary heart disease, atrial flutter, mitro-aortic disease, rheumatoid arthritis, Sjögren's syndrome, hypertension and hepatitis C presented with longstanding immunosuppression
She was receiving prednisone 5-20 mg/day (dose reduction due to ulcerative colitis), acenocoumarol, acenocoumarol, acenocoumarol, atenol, prednisone
She presented with a one-week history of asthenia and progressive swelling of the anterior face of both types of erythema associated with a poorly defined tenderness, fever > 38°C and tachycardia.
There were no gastrointestinal, genitourinary or neurological symptoms.
She was hospitalized due to sepsis secondary to septic arthritis. Treatment was initiated with cefazolin 1 g every 8 h IV and clindamycin 600 mg every 8 h IV.
High inflammatory parameters with leukocytosis 22,300 cells/mm3 (96% PMN) without alterations in the smear and CRP 2.87 mg/dL (normal value < 1.0 mg/dL normal urine sediment) were found in the admission tests.
Two hemocultives were taken at the admission of the hospital; one of them was positive for L. alaprazole; 22.5 h inflammatory remission was achieved with beta-identified by MS MALDI-TOF; and positive for C.
An echocardiogram ruled out infective endocarditis.
Its epidemiological history included occasional consumption of undercooked foods.
Despite the good systemic response, the appearance of retiform purpuric lesions was observed during hospitalization, which coalescated in the face of purplish plaques of both anterior border stellate and livedo racemosa.
These plaques rapidly progressed to blisters and epidermal necrosis.
The patient was evaluated by pathology where septic vasculitis versus vasculitis secondary to rheumatoid arthritis was diagnosed, so a skin biopsy was performed.
Histopathological examination of the lesions showed a polymorphous interstitial dermal infiltrate with lymphocytes, polymorphonuclear cells and eosinophils, associated with an inflammatory infiltrate of neutrophils in the dermal vessels, with leukocytoclasia.
Gram stain of the tissue showed Gram-positive cocci with negative PAS staining.
The findings were compatible with septic vasculitis caused by Lis spp.
No tissue cultures were performed.
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The associated antimicrobial therapy was maintained and treatment with systemic corticosteroids (prednisone 0.5 mg/kg/day) was initiated, as well as local management of lesions with debridement, daily healing and topical application of 2% clopicine base.
After completing 7 days of clindamycin and 14 days of IV ampicillin, the patient experienced a favorable evolution of cutaneous lesions.
She was discharged with oral antibiotic therapy with amoxicillin 500 mg every 8 h for 14 days.
Finally, after four months of treatment, complete resolution of skin lesions was achieved with two-week dermatological cures.
