Is this mildly pruritic eruption a bacterial infection-or something else?

August 4, 2009

This pruritic rash developed in a 43-year-old woman who had undergone a lumpectomy and lymph node dissection for breast cancer. She completed radiation therapy and chemotherapy 3 weeks ago. The rash has been present for 5 days. Levofloxacin was started 1 day ago.

Case 3:
This pruritic rash developed in a 43-year-old woman who had undergone a lumpectomy and lymph node dissection for breast cancer. She completed radiation therapy and chemotherapy 3 weeks ago. The rash has been present for 5 days. Levofloxacin was started 1 day ago.

Which of the following would you include in the workup?

A. Bacterial culture.
B. Fungal culture.
C. Viral culture.
D. Skin biopsy.
E. CT scan.

Which of these regimens would you prescribe pending workup results?

F. Cephalexin, 500 mg 3 or 4 times a day.
G. Doxycycline, 100 mg bid.
H. Fluconazole, 100 mg/d.
I. Valaciclovir, 500 mg bid.
J. Famciclovir, 250 mg bid.
K. Valaciclovir, 1 g tid.
L. Famciclovir, 500 mg tid.
M. Application of a mid-potent topical corticosteroid
cream twice a day.

(answers on next page)

Case 3:Probable contact dermatitis

Levofloxacin was continued, and fluconazole, H, was added to the patient’s regimen. She was given a topical sulfur/sulfacetamide cream as well as desonide lotion. During the following week, no change was observed in the rash. She was then given fluocinonide cream, M, and the rash completely resolved. The patient subsequently remembered that she had used an antibiotic salve to which she apparently had an allergic contact dermatitis.

The patient’s response to a topical corticosteroid suggested the diagnosis of a follicular pattern for her irritant or contact dermatitis.