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.