Letting the Patient off the Hook

Stage A 27-year-old man was hospitalized in late September 1998 with a three-day history of low-grade fever and malaise accompanied by a nonproductive cough, without dyspnea, chills, dysuria, or diarrhea. He also had a pruritic rash covering the gluteal region. The rash and itching had started about two weeks earlier, during the last week of a month-long vacation on the coast of Thailand, and had increased in intensity despite topical treatment with fusidic acid (Fucicort) cream and calamine lotion. Two days before the patient was admitted, a dermatologist in Israel had diagnosed folliculitis and prescribed 2 g of cephalexin daily. . . .