Annulare Centrifugal Erythema Erupted by P. Mirabilis Infection , that Mimics an Allergic Drug Reaction

The classification of annular centrifugal erythemas can be confusing and has always been one of the most discussed issues in medicine. We report a case of 58 years old woman who had a 3 -days post vaginal-plastic surgery. The patient presented non-pruritic annular skin eruptions on the abdomen and extremities, spreading gradually and forming large rings. She was treated during this period at the gynecologist department and later was admitted to a tertiary care hospital with the diagnosis "enoxaparin-sodium drug" reaction. The skin lesion was not associated with the drug allergy reaction. Urino-culture grew Proteus Mirabilis, Vulgaris. Presence of Proteus mirabilis and annular centrifugal erythema eruption lesions, suggests a pathogenetic effect of the gram-negative bacterium on the skin lesion. Considering the anamnesis and the clinical manifestation, the patient was treated with antibiotic therapy, corticosteroid therapy, anti-histaminic and local corticosteroid cream. To our knowledge, no other case of EAC associated with Proteus mirabilis infection has been published.