Diffuse rash and cough in elderly woman with a UTI.
A 66-year-old woman came into the emergency department with a diffuse rash and a cough. She had a rash on the palms of her hands, which had developed the day before, but had improved a bit. She also had a rash on her feet, legs, and lower abdomen, which had developed that morning. She said that over the previous 2 days she had had a fever, dry cough, and some difficulty breathing. Her past medical history was significant for asthma, diabetes, hypertension, and osteoarthritis. Her medications included atenolol, celecoxib, metformin, pioglitazone, and an albuterol inhaler, as needed. In addition, she was on the ninth day of a 10-day course of nitrofurantoin for acute cystitis. She was allergic to ampicillin and erythromycin. On physical exam, she had a fever of 101.5 degrees Fahrenheit. On lung examination, she had diffuse wheezes and mild bibasilar crackles. Examination of her skin revealed a nonpainful, nonpruritic, erythematous, maculopapular rash located on the palms and legs, as well as on her lower abdomen. Chest radiograph showed mild opacification in the bases of the lungs. What is your diagnosis?
Baird
Drew
D
Dwight D. Eisenhower Army Medical Center, Fort Gordon, GA, USA. drew.baird@us.army.mil
Bush
Robert Joel
RJ
Seehusen
Dean
D
D000368:Aged; D000892:Anti-Infective Agents, Urinary / Q000008:administration & dosage / Q000009:adverse effects*; D003371:Cough / Q000139:chemically induced*; D003556:Cystitis / Q000188:drug therapy; D004417:Dyspnea / Q000139:chemically induced; D005076:Exanthema / Q000139:chemically induced*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007958:Leukocyte Count; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000139:chemically induced*; D009582:Nitrofurantoin / Q000008:administration & dosage / Q000009:adverse effects*; D011859:Radiography; D014552:Urinary Tract Infections / Q000188:drug therapy*
D000892:Anti-Infective Agents, Urinary; D009582:Nitrofurantoin