PMC9717603_01
Pictures of hands (A), calves (B) and left thigh (C) at admission showed serious erythema, ulcers and depressed scars; H&E staining figures (D, 40x and E, 100x) of a right calf erythema showed dermal perivasculitis and subcutaneous fat inflammation.
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On admission, physical examination revealed numerous massive infiltrative erythema on her four limbs, some of which had been developed into ulcers covered with yellow-white purulent secretions or depressed scar with brown pigmented spots (Figure 1A-C). Histopathology of the right calf erythema showed dermal perivasculitis and subcutaneous fat inflammation (Figure 1D and E).
(A) A new rash on the left Hip after abscess drainage; (B) the rash was aggravated after antibiotic treatment; (C) H&E staining of a left Hip erythema showed features of purulent inflammation that involved with dermis and subcutaneous fatty tissue (25x).
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Abscess incision and drainage were then performed, yet the range of redness and swelling was further enlarged under the condition of ceftazidime treatment (Figure 2A). The rash did not aggravate in the next three days, but more serious pain and redness were presented in the 4th day after change of the treatment regimen (Figure 2B). Tissue biopsy was performed on her left hip and histopathology showed features of purulent inflammation that involved with dermis and subcutaneous fatty tissue (Figure 2C).
Pictures of hands (A), calves (B) and the new rash of the left hip (C) at discharge indicated skin lesions were improved as compared with admission; (D) picture of the new rash at re-examination indicated further improvement.
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Fluorescence Diagnostic Kit (Sansure Biotech, China). Five days after empirical treatment, skin lesions of the patient were improved (Figure 3A-C) and she discharged from our hospital with drugs changed to josamycin, doxycycline and moxifloxacin because the susceptibility testing using the mycoplasma IES test kit (Zhuhai Encode Medical Engineering, Ltd, Guangdong, China) indicated this stain was susceptible to josamycin, doxycycline and minocycline. Two weeks after discharge, re-examination showed further improvements in her skin lesions (Figure 3D).