A bedridden 85-year-old woman with advanced multi-infarct dementia is presented from a nursing home for evaluation of a rash on her abdomen with a possible skin infection at her gastrostomy tube (G-tube) site.
The nursing-home staff first noticed the rash 2 days ago. It apparently began after levofloxacin therapy was started for a urinary tract infection. Because skin creases and the umbilicus were involved, a topical antifungal was started, but no improvement was noted. The patient has no fever or rigors.
On physical examination, the patient smiles when spoken to and has good ocular tracking, but she cannot meaningfully verbalize and follows only the simplest of commands. Her vital signs are within normal limits, and she appears to be in no distress. Other than baseline right-hemiparesis, examination yields unremarkable results except for the skin findings."
The nursing-home staff first noticed the rash 2 days ago. It apparently began after levofloxacin therapy was started for a urinary tract infection. Because skin creases and the umbilicus were involved, a topical antifungal was started, but no improvement was noted. The patient has no fever or rigors.
On physical examination, the patient smiles when spoken to and has good ocular tracking, but she cannot meaningfully verbalize and follows only the simplest of commands. Her vital signs are within normal limits, and she appears to be in no distress. Other than baseline right-hemiparesis, examination yields unremarkable results except for the skin findings."
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