A 16-month-old child presenting with recurrent bilateral otitis media developed a localized pustular rash following treatment with Amoxicillin and subsequent switching to Cefdinir. Pediatricians evaluated the infant through electronic health record photo submissions and in-person examinations.
A Toddler’s Recurrent Ear Infections and Changing Antibiotics
The patient, a toddler in generally good health with up-to-date vaccinations, presented in May with fussiness and an earache. Clinicians diagnosed bilateral otitis media and prescribed Amoxicillin. One month later, the child returned with identical symptoms and received a second course of Amoxicillin. During this second round, the patient’s mother reported a rash appearing on the second day of treatment. The mother also noted a family history of a Penicillin allergy in the maternal grandmother. Medical staff discontinued Amoxicillin, transitioned the patient to Cefdinir to manage the ongoing ear infections, and added Claritin to address the skin reaction. Caregivers transmitted photographs electronically through the electronic medical record system.
Worsening Symptoms and Rapidly Escalating Treatment
The day following the medication adjustment, the mother contacted the clinic to report a worsening rash that had spread from the right hip—directly over a known hemangioma—to the ipsilateral anterior thigh. Practitioners added oral steroids to the treatment protocol. During an in-person evaluation the following day, physical examination revealed islands of erythematous, lichenified skin accompanied by scabs across lesions in various stages and shapes, with some resembling target lesions. Because the ear examination was entirely normal, clinicians stopped the Cefdinir, oral steroids, and antihistamines after determining the medications provided no clinical benefit.
Advancing Lesions and Polymerase Chain Reaction Confirmation
Two days after the clinic visit, the patient returned as the rash continued to advance. Examination revealed pustules emerging amid erythematous macules, without vesicles or crusting lesions. There were no complaints of pain, tingling, itching, or excoriation. Medical staff unroofed a single lesion and submitted the sample for polymerase chain reaction testing.
Related reading