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A 70-year old man developed drug eruption during treatment with rituximab and azithromycin [azitromycin; dosages, routes and time to reaction onset not stated]; he also remained seronegative for neuroborreliosis in a wide array of serologic tests due to rituximab.
The man presented on 12 July 2016 with a 3-week history of intermittent fever, myalgia, headaches, tinnitus and an exanthema, which had started under his left eye. His history was significant for a mantle cell lymphoma (a B-cell nonHodgkin's lymphoma) in 2010 and its relapse in 2015; both episodes were successfully treated with R-CHOP with complete response. He was continued on rituximab maintenance every other month until July 2016. He received treatment with azithromycin for his current symptoms. There were generalised nummular to palm-sized non-pruritic erythematous macules, sparing his foot soles, which were considered either a drug eruption or a para-infectious skin reaction. An abdominal skin biopsy revealed non-specific chronic perivascular dermatitis, deemed consistent with a hypersensitivity response. A PCR...