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Rash with infection not responded with VANCOMYCIN, METRONIDAZOLE.

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Sirs,
I would like to ask you for the condition of my father. He is in the hospital for 5 weeks due to infection which was conformed by blood test results:
CRP was 174 and sedimentation 80 and high leucocytes. He was received in the hospital and received vancomycin, Meronem and Metronidazol infusion for about 25 days. On the day 20. his CRP was normal but his palms got red (with rush) and itchy. He continued to receive antibiotics. Then the legs appeared with rash also and with edoema. The doctors then decided to stop antibiotics on the day 25. He was at the dermatologist and she said it was exantema mtoxi - all -T78.4 and therapy Aerius, methyprednizolone and betametazone locally. The doctors in the hospital decided not to give him systemic corticosteroids but only locally and Aerius. But he fainted and got chills and rush got worse by the night and doctors they started yesterday with methylprednisolone inj 60 mg daily. He stabilized, but the rash is a little bit worse today and his arms and legs has oedema.

I am sending you the pictures of the rash. Please could you advice what this would be about and what would be the treatment since I am worried very much.

Thank you.

Tatjana


Category: Family Physician-GP

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Category: Sexually Transmitted Diseases(STD)Specialist
Dr. Deepu Sebin Sebastian is online now

Expert:  Dr. Deepu Sebin Sebastian replied 4 Days.

Thanks for your query at DoctorSpring.com
I understand your concern
It looks like your father has an allergic response to either the infection or the antibiotics he has been administered for the infection. I request you to upload culture reports for his infections as well as other investigations that have been done until now like CBC, electrolyte, LFT, KFT etc.
Please revert back so that I can give you my opinion
Regards


Patient replied :

Dear dr Sebastian, Thabk you veru much for the answer. In the hospital they are doing investigations and cultures but they havent isolated any bacteria since thay said it is hard to isolate and they had to give them these strong antibiotics for anycase because crp was high. I am worried now about this strong alergy reaction. Is it dangerous? It is all over the body and dermatologist has gave him today methylprednisolone infusion twice a day 40mg and antihystamine and told to stop receiving all medicines including propafen also as it is usual therapy from april this year.. He had chills and fever today and temperature around 37.6. Could it be because of allergy and how dangerous is this condition? What do you think about terapy he is receving and how long corticosteroids are allowed to be received by infusion? Thank you in advance for your answer. Kr, Tatjana


Expert:  Dr. Deepu Sebin Sebastian replied 3 Days.

Hello,
It is not impossible to isolate any bacterium if there is an infection. I am not able to understand why your doctor said that to you. In fact, correct antibiotic treatment can only be initiated, based on culture and sensitivity reports.
Coming to the patient's condition, the rash is treatable in able hands and I think the doctors are on right track by starting him on steroids. Antihistamines addition may also help. It is also important to continue with antibiotic therapy (with other drugs which patient is not allergic for) until the infection resolves.
Hope it helps
Regards


Patient replied :

Dear dr Sebastian, how can we know if the infection is already resolved? On June 10. CRP was 4.4 and few days ago CRP was 7.4 we presumed that maybe CRP was a little bit above 4 because of allergic reaction. I am also confused how come they didn't isolate bacteria... The doctor has told me that it is difficult to isolate it from the blood. They did hemocultures but the results were negative and doctor told me that they had to include antibiotics as it is the worst case for anycase. First they thought that it was renal apsces because the cyst was blurry on ultrasound but four days latter CT showd that it is cyst simplex so they don't know the cause of infectio. My father has larged prostate (benig) so maybe there could be found the cause but they hasn't investigate it there.But I am afraid that they treated to much him with those three antibiotics ( he is in hospital 5 weeks) and that organism couldn't maybe receive anymore ( I am a pharmacist and have basic understanding). especially vancomicin which my father used to speed a little bit infusion. But confusing thing is that few days after stoping antibiotics alerrgic reaction got worse... Macules used to merge somewhere on the body especially on trunk and chest. The reaction is all over the body...They gave him diclofenac for temperature (he had 38C) and now he swets and temperature probably goes down. Could an alergic reaction be a cause of temperature? Do you consider he still might have iinfectione even though crp and sedimentation was ok yesterday? how can we know if he needs more antibiotics? i am considering to take him to another clinic. could you advice what to do as I gave you more details? Many thanks in advance. KR, Tatjana


Expert:  Dr. Deepu Sebin Sebastian replied 2 Days.

Hello,
Thanks for adding more details. Infection should resolve with a complete course of suitable antibiotics. With resolution fever goes down, CRP level reduces, leucocyte count gradually comes down. From your information, I can see that they could not identify the source of the infection but as condition of the patient is stable now except the rash I think he has responded to antibiotics as Vancomycin and Meropenem are higher antibiotics that might have worked against the infection. I think he won't need antibiotics anymore. The only concern is rash which should respond to the steroids and antihistaminics within a few days.
Hope it was helpful
Regards


Dr. Deepu Sebin Sebastian
Category: Sexually Transmitted Diseases(STD)Specialist
Experience: 
MD, Internal Medicine - Stanley Medical School
Medical School - MBBS - Govt. Medical College, Kottyaam

Diagnostic Prediction - Stanford School of Medicine
Received Specialty training in Critical Care, Cardiology, Neurology, Gastroenterology, Nephrology from Stanley Medical College and in Endocrinology, Rheumatology.

Hematology and Geriatrics from Madras Medical College.
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