A 58-year old woman came to my office because of rash and re | Figure 1
BorisJ87
Infectious Diseases
A 58-year old woman came to my office because of rash and recurrence of skin infection of the right lower leg. Her complaints started ~20 days ago when she developed pain and redness of the anterior part of the right lower leg. She was seen by a dermatologist who made a diagnosis of thrombophlebitis and prescribed her a 7-days course of amoxicillin/clavulanate (1000 mg, bid). After 7 days, she was much better and the dermatologist prescribed only local topical therapy. Three days ago, before her current presentation at my office, she again developed pain and redness in the anterior part of the left lower leg, with fever up to 38.3°C. The next day she was seen by a GP, who again started amoxicillin/clavulanate. On the same day, in the evening, she noticed a rash on her extremities which was slightly pruritic. She continued to use this antibiotic and she felt better (redness of the right lower leg was less intense, pain was less intense, and she didn't have fever anymore), but the rash became more intense and larger. Because of this, she was referred to me. Her past history was unremarkable.
Physical examination: big papules and nodules predominantly on extremities, some confluent, non-tender, hard to touch. The right lower leg had varicose veins, painful to touch in the anterior part in the area of redness (see picture no. 4). The rest of physical examination was unremarkable.
What is your opinion?