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January 1991

Persistent Necrotic Digits in a Patient With the Acquired Immunodeficiency Syndrome

Author Affiliations

Beth Israel Hospital and Harvard Medical School, Boston, Mass

Arch Dermatol. 1991;127(1):113-114. doi:10.1001/archderm.1991.01680010123021

REPORT OF A CASE  A 35-year-old man with a 10-month history of the acquired immunodeficiency syndrome (AIDS) was admitted to the hospital for treatment of several fingers that were presumed gangrenous. His initial presentation to the emergency room 1 week earlier with the presence of pustules led to the diagnosis of paronychia. He was treated with cephalexin orally and was told to return 1 week later, at which time several of his fingers appeared necrotic. Amputation of the involved digits was considered. Preoperative examination revealed hematologic and electrolyte abnormalities, necessitating transfer to the medical service. Cultured material from the previous week revealed coagulase-negative Staphylococcus aureus, and the patient was treated with intravenous cefazolin and penicillin. Roentgenograms of his hand revealed softtissue swelling without evidence of osteomyelitis. Oral erosions were treated with nystatin (in oral suspension). Improvement in the fingers was noted for the first 2 days of antibiotic treatment. During

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