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Fevers, chills, hypotension, and a generalized seizure occurred in a 57-year-old man who had undergone splenectomy for stage IV non-Hodgkin's lymphoma three years earlier. He was treated initially with ceftriaxone, vancomycin, and rifampin. A Gram's stain of the cerebrospinal fluid showed gram-positive organisms in pairs and short chains, but cultures of cerebrospinal fluid were negative. A latex-agglutination test was positive for Streptococcus pneumoniae. During the next several days, disseminated intravascular coagulation and symmetric areas of pallor developed on the back of both hands and the soles of the feet, with overlying bullae. Cultures of the bullous fluid were sterile. . . . [Full Text of this Article] |
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