Safe Use of Therapeutic-Dose Oral Isotretinoin in Patients With a History of Pseudotumor Cerebri

tissue culture, and from a papule for hematoxylin-eosin staining. Within an hour of obtaining the specimens, the pathologist reported frozen section findings of small organisms within the vasculature suggestive of either fungal spores, likely histoplasmosis, or staphylococcal bacteria. Permanent sections revealed a large neutrophilic pustule with inflammation extending throughout the dermis and prominent necrosis with basophilic structures filling necrotic vascular spaces (Figure 2A). Tissue Gram staining confirmed gram-positive cocci in the vessels (Figure 2B). Tissue culture, blood culture, bronchial washings, and fluid from bilateral empyemas all grew CA-MRSA. Results from transthoracic echocardiogram and bone scans were negative. Magnetic resonance images of the brain showed multifocal lesions, likely septic emboli. Findings from workup for possible immunodeficiency were negative. The patient was sent to a rehabilitation facility to complete a 6-week course of intravenous vancomycin.