Case 19-1999

Presentation of CaseA 55-year-old man was admitted to the hospital because of a painful right tibial lesion.Twenty-one months before admission, the patient had undergone orthotopic liver transplantation at this hospital because of cryptogenic cirrhosis. The donor liver was fatty and suboptimal, and it was replaced with a second liver one month after the first transplantation. Insulin-dependent diabetes mellitus subsequently developed. Sixteen months before the current admission, a biopsy-confirmed acute rejection reaction was managed successfully.Thirteen months before the current admission, the patient was readmitted to the hospital because of Enterobacter cloacae sepsis, which was thought to have originated . . .