Day 2: Infectious Disease Consultation
After a review of patient history and a thorough physical examination, the consulting physician suggests a differential diagnosis of DRESS syndrome (secondary to clindamycin) vs. vasculitis vs. Bartonella henselae infection. Additionally, the physician orders an echocardiogram to rule out endocarditis while awaiting blood culture results. Two 4 mm punch biopsies are performed, sampling lesions from the patient’s left lower leg. The patient’s antibiotic regimen is switched to vancomycin, doxycycline, and cefepime for a broader spectrum of coverage. Lastly, a Bartonella assay is drawn.