Post Operative day

Clinical evolution

Medical conduct

2nd

Patient presented a cutaneous rash in the abdomen and lower limbs (Figure 1), associated with mild pruritus.

Dexchlorpheniramine. Suspended potential skin-reactive drugs such as dipyrone and diclofenac.

3rd

The skin rash remained, now with periumbilical area with phlogistic signs, without contiguity with operative wound. Patient also presented desaturation in ambient air (90% capillary oxygen saturation), associated with dyspnea and productive cough. Tachycardia and subfebrile peak of axillary temperature (37.7˚C) were present, with no change in pulmonary auscultation.

Screening tests for fever of unknown origin were requested, which revealed left leukocytosis (15.380 leukocytes with 6% of sticks), increase in C-reactive protein (318.9), X-ray with discrete bilateral diffuse infiltrate and no consolidations (Figure 2). Therefore, empirical use of antibiotic combination with piperacillin, tazobactan and azithromycin was considered due to possible infectious disease of unknown focus.