The first case is a patient on prolonged OPAT for MRSA bacteremia, toe osteomyelitis, and possible endocarditis who re-presented with fever, cough, pulmonary opacities, infusion-associated symptoms, profound neutropenia, and recent eosinophilia. The case highlights how recurrent fever during antibiotic therapy can be misattributed to persistent infection, thrombosis, or pneumonia when the antibiotic regimen itself may be driving the presentation. The teaching portion reviews adverse events during outpatient parenteral antimicrobial therapy, especially beta-lactam-associated neutropenia and hypersensitivity-like reactions.
The second case is a patient with MSSA endocarditis who develops elevated LFTs and a vasculitis rash. Although the patient had a negative HCV screen (antibody) on admission, a HCV PCR revealed acute hepatitis C. The teaching portion reviews how vasculitis can occur from cryoglobulinemia, antibiotics, or endocarditis.