4th

Onset of lesions on the back. Patient presented febrile peaks of axillary temperature between 38˚C and 39˚C.

The antimicrobial was maintained and a consulting for the Dermatology team was requested.

6th

Despite the antibiotic therapy, patient maintained febrile peaks and the appearance of pustules in abdomen and lower limbs was verified (Figure 3).

Abdominal ultrasound revealed a heterogeneous net formation located in intra-abdominal topography, interposed between the anterior abdominal wall and the uterus (8.8 × 1.5 × 8.5 cm), with possibility of postoperative blood collection. C-reactive protein remained high (285.8).

6th

Exploratory laparotomy: purulent secretion was identified from the subcutaneous tissue to the aponeurosis. Abdominal cavity without collections or active bleeding. Cavity and subcutaneous lavage was carried out. Bacteriological subcutaneous collection was requested, showing absence of bacterial growth. A biopsy of the skin lesions was performed. The diagnostic hypothesis was AGEP and the use of Azithromycin suspended.

9th

There was an important improvement of the skin lesions, presenting pustules only in the root of the thighs and areas of desquamation (Figure 4).

Patient was kept on Piperacillin and Tazobactan for 10 days after reintervention, being discharged on the 18th postoperative day, remained afebrile and with an operative wound in second intention healing.

26th

Ambulatory segment. Progressive improvement of skin lesions. No fever episodes. Operative wound in second intention healing.

Ambulatory return in 1 week, patient did not attend.