Refractory skin lesion, hypertension and acute kidney injury in a young boy: Questions

Excerpt

A previously healthy 12-year-old obese Caucasian boy presented to an urgent care clinic in August 2015 with a left pretibial hyperemic pustule-like bump. He denied any recent trauma but recalled that there might be an insect bite. He was otherwise asymptomatic on presentation. He was started on oral clindamycin for suspected cellulitis. The lesion improved significantly after 5 days of antibiotic treatment. Two days after completion of clindamycin therapy the lesion became hyperemic and warm again, and a new lesion developed in proximity to the first one (Fig. 1). The lesions became more inflamed with ulceration and serous drainage. The patient underwent incision and drainage of the lesions with negative wound cultures. He was treated with trimethoprim-sulfamethoxazole, clindamycin and prednisone without any resolution. In late September, he underwent a skin lesion biopsy. Pathological diagnosis was pyoderma granulosum versus atypical infection. During this time an ulcer developed with purulent, malodorous drainage. The patient had increasing pain in his left leg but did not have any other symptoms.

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