A 28-year-old woman with an infected proximal femur nonunion was treated with an antibiotic-coated intramedullary nail. Shortly after discharge, the patient presented to the emergency department and was readmitted with a morbilliform rash sparing the left lower extremity. She became hemodynamically unstable, despite cessation of intravenous antibiotics, requiring transfer to the intensive care unit and urgent removal of her antibiotic nail. She improved after surgery, and biopsy results from the rash confirmed acute generalized examthematous pustulosis.
Acute generalized exanthematous pustulosis is a rare, dermatologic crisis that can be precipitated by antibiotics, even in the form of antibiotic cement.