ID Fellows Cup Question 13

27-year-old woman with history of right tibia plateau fracture status post open reduced internal fixation a year ago, recently returned with tibial osteomyelitis confirmed by bone biopsy.

Culture was positive for methicillin-resistant Staphylococcus aureus. She was discharged on Vancomycin through a PICC line.

Two weeks later she returns to the ED with fever and rash. One of her children has been sick with an upper respiratory tract infection but without fever or rash.

Exam notable for fever to 101.6 F, facial edema and an erythematous rash (pictured below), coalescent, on her trunk and extremities without mucosal involvement. Cervical lymphadenopathy is present.

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