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Intertriginous Bullae in a 53-Year-Old Man
Anwell Chang, MD;
Charles Camisa, MD;
Adrian Ormsby, MD
Cleveland Clinic Foundation, Cleveland, Ohio
Arch Dermatol. 2001;137:815-820.
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REPORT OF A CASE
A 53-year-old man underwent coronary artery bypass surgery and mitral valve repair. Five days later, ciprofloxacin therapy was begun after the patient was noted to have thick, yellow sputum. He returned home, and on postoperative day 11, he presented with mediastinitis and septic shock. Therapy with vancomycin was initiated. His other medications included ciprofloxacin, famotidine, paroxetine, digoxin, procainamide, and fentanyl. Two days later, small bullae confined to the intertriginous areas appeared and progressively worsened. Blood cultures yielded methicillin-resistant Staphylococcus epidermidis, and treatment with rifampin and gentamicin was begun.
Physical examination revealed extensive symmetrical tense bullae arising on erythematous bases in the intertriginous (axilla [Figure 1], groin, and inframammary) areas. The mucous membranes, palms, and soles were spared.
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Figure 1.
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A biopsy specimen from the right axilla was obtained (Figure 2). The results of direct immunofluorescence using . . . [Full Text of this Article]
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