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Hilary L. Reich, MD; Glen H. Crawford, MD; Michelle T. Pelle, MD; William D. James, MD

Arch Dermatol. 2004;140:163-166.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

REPORT OF A CASE

A 42-year-old man who had undergone splenectomy presented with a 12-hour history of fever, chills, malaise, nausea, and vomiting, and a temperature of 39°C. On admission, therapy with intravenous levofloxacin and metronidazole was initiated. Six hours later, the patient became increasingly disoriented, and his blood pressure rapidly dropped. Severe respiratory distress developed, leading to intubation and transfer to the intensive care unit. Intravenous fluids, vasopressors, and broad empiric antibiotic coverage with vancomycin and gentamicin sulfate were commenced at that time. Cerebrospinal fluid and urine cultures were negative, and a chest radiograph was normal. However, within 24 hours, blood cultures grew gram-positive cocci in pairs and chains, which later proved to be group B streptococcus. Based on known sensitivities, antibiotic therapy was changed to therapy with cefazolin sodium and clindamycin phosphate.

Despite aggressive treatment, over . . . [Full Text of this Article]

DIAGNOSTIC CHALLENGE

COMMENT

From the University of Pennsylvania Medical Center, Philadelphia.