PMC8121494_01
Clinical course before and after treatment for hypotensive shock. Time flows from left to right, and corresponding information on changes in clinical laboratory data are aligned vertically. SS, sodium succinate; TMP/SMX, trimethoprim/sulfamethoxazole; HD, hemodialysis; PE, plasma exchange; IVIg, intravenous immunoglobulin; AST, aspartate aminotransferase; ALT, alanine aminotransaminase; ALP, alkaline phosphatase; gamma-GTP, gamma-glutamyl transpeptidase.
fonc-11-681997-g001.jpg
PMC8121494_01_fonc-11-681997-g001.jpg
f1
She also had an elevated number of white blood cells, increased C-reactive protein and hepatic enzyme serum levels, a decreased platelet count, and a coagulation abnormality ( Figure 1 ). Although TMP/SMX was discontinued on Day 1, a maculopapular rash around the mouth strengthened and spread to the entire face, neck, trunk, and extremities in parallel with elevated levels of hepatobiliary enzymes on Days 3 and 5 ( Figure 1 ).
Clinical course of the skin rash after admission to the intensive care unit Edematous erythema appeared on the face, especially highlighted in the periorbital and perioral regions on Day 3 (A). The skin rash was enhanced in spite of high-dose steroid therapy between Days 3 and 5 (B). A maculopapular rash spread through the chest (C-1) and abdomen (C-2) on Day 7. The condition gradually disappeared by Day 12 after intravenous immunoglobulin therapy and subsequent steroid mini-pulse therapy (D).
fonc-11-681997-g002.jpg
PMC8121494_01_fonc-11-681997-g002.jpg
f2
Edematous erythema, highlighted focally in the periorbital and perioral regions, was enhanced in spite of high dose steroids, between Days 3 ( Figure 2A ) and 5 ( Figure 2B ), and subsequently spread through the chest ( Figure 2C-1 ) and abdomen ( Figure 2C-2 ). She had a good response to these treatments and recovered well from her severe condition ( Figure 2D ).