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A 34-year-old male with a past medical history of hepatitis C and intravenous (IV) drug abuse was admitted to the hospital with methicillin sensitive Staphylococcus aureus (MSSA) infective endocarditis complicated by septic pulmonary emboli, cervical osteomyelitis with soft tissue extension, bacteremia and acute kidney injury. On hospital day four, the patient abruptly developed a folliculitis-like rash on bilateral upper extremities for which dermatology was consulted. He denied any associated symptoms including itching, burning or pain. Prior to consultation, he was treated with vancomycin, cefazolin, linezolid, and dialysis. On physical examination, the patient had pink to purple papules on the bilateral distal upper extremities (Figure 1), some of which were eroded. Distal lower extremities revealed scattered, non-blanching, bright pink macules. On re-examination three days later, the lesions on the bilateral upper extremities had evolved into larger, inflamed, firm, pink, centrally umbilicated, semi-translucent papules (Figure 2), with few newly developed scattered similarly appearing lesions on the bilateral lower extremities. The previous macules on lower extremities persisted and were unchanged. Seven days after initial presentation, the lesions began to spontaneously involute, leaving pink, crusted papules and macules without scars. The eruption continued to fade over the course of two weeks despite ABSTRACT

Sterile Neutrophilic Folliculitis with Vasculopathy in a Young Male Patient with Infective Endocarditis