case_images: PMC8121494_01
case_images: Clinical course before and after treatment for hypotensive shock. Time flows from left to right, and corresponding information on changes in clinical laboratory data are aligned vertically. SS, sodium succinate; TMP/SMX, trimethoprim/sulfamethoxazole; HD, hemodialysis; PE, plasma exchange; IVIg, intravenous immunoglobulin; AST, aspartate aminotransferase; ALT, alanine aminotransaminase; ALP, alkaline phosphatase; gamma-GTP, gamma-glutamyl transpeptidase.
case_images: fonc-11-681997-g001.jpg
case_images: PMC8121494_01_fonc-11-681997-g001.jpg
case_images: f1
case_images: She also had an elevated number of white blood cells, increased C-reactive protein and hepatic enzyme serum levels, a decreased platelet count, and a coagulation abnormality ( Figure 1 ). Although TMP/SMX was discontinued on Day 1, a maculopapular rash around the mouth strengthened and spread to the entire face, neck, trunk, and extremities in parallel with elevated levels of hepatobiliary enzymes on Days 3 and 5 ( Figure 1 ).
case_images: Clinical course of the skin rash after admission to the intensive care unit Edematous erythema appeared on the face, especially highlighted in the periorbital and perioral regions on Day 3 (A). The skin rash was enhanced in spite of high-dose steroid therapy between Days 3 and 5 (B). A maculopapular rash spread through the chest (C-1) and abdomen (C-2) on Day 7. The condition gradually disappeared by Day 12 after intravenous immunoglobulin therapy and subsequent steroid mini-pulse therapy (D).
case_images: fonc-11-681997-g002.jpg
case_images: PMC8121494_01_fonc-11-681997-g002.jpg
case_images: f2
case_images: Edematous erythema, highlighted focally in the periorbital and perioral regions, was enhanced in spite of high dose steroids, between Days 3 ( Figure 2A ) and 5 ( Figure 2B ), and subsequently spread through the chest ( Figure 2C-1 ) and abdomen ( Figure 2C-2 ). She had a good response to these treatments and recovered well from her severe condition ( Figure 2D ).