July/August 2003

 

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History:

A 24 year-old black female developed fevers 1 week after Cesarean section for twins. She presented to her primary gynecologist who prescribed Keflex for a post-operative wound infection. The patient's fever persisted and she presented to her local hospital. During the patient's hospitalization, she developed an episode of transient visual loss and confusion that was diagnosed as hysterical blindness. She also developed generalized pustules and worsening mental status. She was transferred to Barnes-Jewish Hospital Medical ICU.

Physical Exam:

The patient had fever (41°C), confusion, and a faint systolic ejection murmur heard best at the apex. Her initial dermatologic exam was significant for diffuse pustules on the face, trunk, and extremities (Figs 1 and 2). Her recent surgical scar was erythematous with purulent discharge.

 

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