Nitrofurantoin-Induced Exfoliative Dermatitis: A Case Report.

Exfoliative dermatitis (ED) is a rare and life-threatening dermatological emergency caused by a wide range of cutaneous or systemic conditions, such as inflammatory dermatosis, drug reactions, and malignancies. We report a case of a 77-year-old man who developed ED five days after starting nitrofurantoin. The drug was withdrawn, and the patient was treated with topical corticosteroid and supportive care, after which there was a full recovery within a week. This report describes an uncommon entity with a guarded prognosis that requires proper diagnosis and management.

Acute Pyelonephritis Associated with Ruptured Abdominal Aortic Aneurysm: An Unusual Presentation.

We describe a rare presentation of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A 68-year-old female presented to the emergency department with a 3 day history of cystitis. General examination revealed the acute onset of pain in the left flank accompanied by fever and chills. Blood tests revealed leucocytosis 25,400×109/L and C-reactive protein 495 mg/L (<6.1), while urinary sediment analysis revealed many leucocytes and gram-negative bacteria. The patient was admitted with acute pyelonephritis. On the third day of admission, the urine culture isolated Escherichia coli sensitive to the antibiotic prescribed; however, the patient clinically deteriorated. A computed tomography scan revealed a ruptured abdominal aortic aneurysm involving the left renal artery. The patient underwent an exploratory laparotomy but uncontrollable haemorrhage led to a fatal outcome. This case highlights a rare case of acute pyelonephritis associated with a ruptured abdominal aortic aneurysm. A computed tomography scan or abdominal ultrasound should be considered whenever a patient has acute pyelonephritis with a C-reactive protein >400 mg/L in order to exclude complications and other potentially fatal pathologies. LEARNING POINTS: Acute pyelonephritis can lead to a ruptured abdominal aortic aneurysm.There should be a high index of suspicion for other concomitant acute pathologies in patients with pyelonephritis and a C-reactive protein >400 mg/L.A low threshold for abdominal imaging, either a computed tomography scan or abdominal ultrasound, may allow for the diagnosis of pathologies with a high mortality rate, such as a ruptured abdominal aortic aneurysm, at an early stage and thus result in better prognosis.