- A 69-year-old man with prostatism requiring urinary catheterization underwent elective transrectal biopsy of the prostate due to a prostatic mass. Preoperatively 2 prophylactic doses of 500 mg. ciprofloxacin were administered orally. The patient had a history of multiple antibiotic courses given for recurrent urinary tract infections. Ten days after the procedure the patient was admitted to the hospital with respiratory distress and hemoptysis. At hospitalization he was hernodynamically stable and afebrile. Physical examination demonstrated a purulent urethral discharge. Laboratory evaluation revealed leukocytosis, thrombocytopenia, acute renal failure and severe hypoxemia with metabolic acidosis. Shortly afterward patient condition suddenly deteriorated and he was transferred to the intensive care unit. Severe sepsis was suspected. Multiple cultures were obtained, and treatment with intravenous fluids and piperacillin-tazobactam was initiated. The next day we noted multiple erythematous cutaneous nodules consistent with the diagnosis of ecthyma gangrenosum (see figure). Emergency explorative laparotomy showed no abscess or fluid collection.