Radiographic findings of thick walled cavities in the lungs are typically seen in mycobacterial infections, malignant lesions, fungal infections, pulmonary vasculitis or other inflammatory lesions of the lungs. Necrotizing infections of the lungs caused by gram negative bacteria (Klebsiella, Psudomonas, Legionella) and Staphylococcus aureus may also form cavities of varying thickness, with consolidation. Escherichia coli pneumonia causing pulmonary cavities is very rare and the few cases reported are of pneumatocele formation. Here we present an unusual case of Escherichia coli infection as a rare cause of bilateral cavitating necrotizing pneumoniae, in a 67 year old male with uncontrolled type 2 diabetes mellitus.

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Drug reaction with eosinophilia and systemic symptoms syndrome is a syndrome with a varied spectrum of clinical features. The cutaneous manifestations can be an urticarial, maculopapular eruption also including, vesicles, bullae, pustules, purpura, target lesions, facial edema, cheilitis, and erythroderma. Systemic manifestations include lymphadenopathy, fever, and leukocytosis (often with eosinophilia or atypical lymphocytosis), as well as hepatitis, nephritis, pneumonitis, myositis, and gastroenteritis, in descending order. Diagnosis can be made on the basis of the clinical picture and the RegiSCAR (Registry of Severe Cutaneous Adverse Reaction group) scoring system. Here, we present the case of a 40-year-old male with a history of herbal medicine intake after which he developed a diffuse skin rash.

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